RESUMO
BACKGROUND: Satellitosis or in-transit metastasis (S-ITM) has clinical outcomes comparable to node-positivity in cutaneous squamous cell carcinoma (cSCC). There is a need to stratify the risk groups. OBJECTIVE: To determine which prognostic factors of S-ITM confer an increased risk of relapse and cSCC-specific-death. METHODS: A retrospective, multicenter cohort study. Patients with cSCC developing S-ITM were included. Multivariate competing risk analysis evaluated which factors were associated with relapse and specific death. RESULTS: Of a total of 111 patients with cSCC and S-ITM, 86 patients were included for analysis. An S-ITM size of ≥20 mm, >5 S-ITM lesions, and a primary tumor deep invasion was associated with an increased cumulative incidence of relapse (subhazard ratio [SHR]: 2.89 [95% CI, 1.44-5.83; P = .003], 2.32 [95% CI, 1.13-4.77; P = .021], and 2.863 [95% CI, 1.25-6.55; P = .013]), respectively. Several >5 S-ITM lesions were also associated with an increased probability of specific death (SHR: 3.48 [95% CI, 1.18-10.2; P = .023]). LIMITATIONS: Retrospective study and heterogeneity of treatments. CONCLUSION: The size and the number of S-ITM lesions confer an increased risk of relapse and the number of S-ITM an increased risk of specific-death in patients with cSCC presenting with S-ITM. These results provide new prognostic information and can be considered in the staging guidelines.
Assuntos
Carcinoma de Células Escamosas , Neoplasias Cutâneas , Humanos , Carcinoma de Células Escamosas/patologia , Estudos de Coortes , Estudos Retrospectivos , Prognóstico , Neoplasias Cutâneas/patologia , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/patologia , Fatores de Risco , Recidiva , Estadiamento de NeoplasiasRESUMO
A newborn presented with extensive rounded and velvety epidermal nevus (RAVEN) with a genetic study of the cutaneous lesions revealing a heterozygous mutation in FGFR2 (p.Cys382Arg). By 2 years of age, the patient developed hair heterochromia and autism spectrum disorder. Although RAVEN was initially associated with fibroblast growth factor 3 (FGFR3) mutations, three cases of RAVEN have been identified with mutations in FGFR2 (p.Ser252Trp) and one case of linear keratinocytic epidermal nevi has been identified with the same mutation as the mutation identified in our patient. This strongly supports the pathogenic role of these mutations.
Assuntos
Transtorno do Espectro Autista , Transtorno Autístico , Corvos , Nevo Sebáceo de Jadassohn , Nevo , Recém-Nascido , Animais , Humanos , Nevo/patologia , Mutação , Cabelo/patologia , Receptor Tipo 2 de Fator de Crescimento de Fibroblastos/genéticaRESUMO
Exserohilum species are environmental molds that may rarely cause skin and nasal infections, especially in immunocompromised children. We present a 3-year-old girl with acute leukemia who presented with a skin infection caused by Exserohilum rostratum. Previously published cases of skin infections by Exserohilum spp. in children are reviewed.
Assuntos
Infecções Oportunistas , Ascomicetos , Pré-Escolar , Dermatomicoses/diagnóstico , Dermatomicoses/tratamento farmacológico , Feminino , Humanos , Hospedeiro Imunocomprometido , Fungos Mitospóricos , Infecções Oportunistas/diagnósticoAssuntos
Colite Ulcerativa , Dermatite Atópica , Síndrome de Job , Anticorpos Monoclonais Humanizados/uso terapêutico , Colite Ulcerativa/diagnóstico , Colite Ulcerativa/tratamento farmacológico , Dermatite Atópica/diagnóstico , Dermatite Atópica/tratamento farmacológico , Feminino , Humanos , Síndrome de Job/diagnóstico , Síndrome de Job/tratamento farmacológico , GravidezAssuntos
Penfigoide Bolhoso , Psoríase , Sarcoidose , Dermatopatias Vesiculobolhosas , Humanos , Penfigoide Bolhoso/complicações , Penfigoide Bolhoso/diagnóstico , Psoríase/complicações , Psoríase/diagnóstico , Sarcoidose/complicações , Sarcoidose/diagnóstico , Dermatopatias Vesiculobolhosas/etiologiaRESUMO
Eccrine spiradenoma is a rare, benign, adnexal skin tumor of the sweat gland. It is frequently solitary and presents as a small lesion in the dermal or the subcutaneous fat layer. Eccrine spiradenomas rarely progress to malignant transformation but they can relapse. Due to its rarity, there have been few reports about the sonographic appearances of eccrine spiradenoma. Sonographic findings were reported in a relapsing case of an eccrine spiradenoma, located in the deep dermal layers and hypodermis of the preauricular region in a middle-aged man. Ultrasound was very useful to suspect the relapse. Histology was correlated with the sonography and discussed the previously reported imaging findings of eccrine spiradenoma and other sweat gland tumors.
Assuntos
Acrospiroma , Neoplasias Cutâneas , Neoplasias das Glândulas Sudoríparas , Acrospiroma/diagnóstico por imagem , Acrospiroma/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Neoplasias Cutâneas/diagnóstico por imagem , Neoplasias Cutâneas/patologia , Neoplasias das Glândulas Sudoríparas/diagnóstico por imagem , Neoplasias das Glândulas Sudoríparas/patologia , UltrassonografiaRESUMO
Recent interest has emerged in the protective role of vitamin D in melanoma survival and is the subject of multiple studies with heterogeneous results. Here, we present a retrospective cohort study of 264 patients with invasive melanoma from a tertiary university hospital. The aim of the study was to analyze the relationship between vitamin D levels and prognosis of melanoma patients. We found that lower vitamin D levels are independently associated with worse overall survival in melanoma patients in concordance with previous studies on other populations. Vitamin D deficiency could play a survival role in melanoma patients,. Future prospective studies are needed to investigate the effect of vitamin D supplementation on melanoma outcomes.
Assuntos
Melanoma , Neoplasias Cutâneas , Deficiência de Vitamina D , Humanos , Estudos Retrospectivos , Vitamina D/uso terapêutico , Deficiência de Vitamina D/induzido quimicamente , Deficiência de Vitamina D/complicaçõesRESUMO
We present a 65-year-old woman with a 10-year history of cutaneous sarcoidosis, refractory to multiple immunosuppressants and biologics. After 10 sessions of conventional photodynamic therapy (PDT) and 6 sessions of daylight PDT, we achieved a satisfactory local control of the lesion, reducing the thickness and orange coloration of the plaque and preventing superinfections, although systemic treatment had to be maintained. PDT could be a useful therapeutic option for cutaneous sarcoidosis.
Assuntos
Ceratose Actínica , Fotoquimioterapia , Sarcoidose , Idoso , Ácido Aminolevulínico/uso terapêutico , Feminino , Humanos , Ceratose Actínica/tratamento farmacológico , Fotoquimioterapia/métodos , Fármacos Fotossensibilizantes/uso terapêutico , Sarcoidose/tratamento farmacológico , Resultado do TratamentoRESUMO
BACKGROUND: H syndrome (HS) is a rare autoinflammatory disease caused by a mutation in the solute carrier family 29, member 3 (SCL29A3) gene. It has a variable clinical presentation and little phenotype-genotype correlation. The pathognomonic sign of HS is cutaneous hyperpigmentation located mainly in the inner thighs and often accompanied by other systemic manifestations. Improvement after tocilizumab treatment has been reported in a few patients with HS. We report the first patient with HS who presented cardiogenic shock, multiorgan infiltration, and digital ischemia. CASE PRESENTATION: 8-year-old boy born to consanguineous parents of Moroccan origin who was admitted to the intensive care unit during the Coronavirus Disease-2019 (COVID-19) pandemic with tachypnoea, tachycardia, and oliguria. Echocardiography showed dilated cardiomyopathy and severe systolic dysfunction compatible with cardiogenic shock. Additionally, he presented with multiple organ dysfunction syndrome. SARS-CoV-2 polymerase chain reaction (PCR) and antibody detection by chromatographic immunoassay were negative. A previously ordered gene panel for pre-existing sensorineural hearing loss showed a pathological mutation in the SCL29A3 gene compatible with H syndrome. Computed tomography scan revealed extensive alveolar infiltrates in the lungs and multiple poor defined hypodense lesions in liver, spleen, and kidneys; adenopathy; and cardiomegaly with left ventricle subendocardial nodules. Invasive mechanical ventilation, broad antibiotic and antifungal coverage showed no significant response. Therefore, Tocilizumab as compassionate use together with pulsed intravenous methylprednisolone was initiated. Improvement was impressive leading to normalization of inflammation markers, liver and kidney function, and stabilising heart function. Two weeks later, he was discharged and has been clinically well since then on two weekly administration of Tocilizumab. CONCLUSIONS: We report the most severe disease course produced by HS described so far in the literature. Our patient's manifestations included uncommon, new complications such as acute heart failure with severe systolic dysfunction, multi-organ cell infiltrate, and digital ischemia. Most of the clinical symptoms of our patient could have been explained by SARS-CoV-2, demonstrating the importance of a detailed differential diagnosis to ensure optimal treatment. Although the mechanism of autoinflammation of HS remains uncertain, the good response of our patient to Tocilizumab makes a case for the important role of IL-6 in this syndrome and for considering Tocilizumab as a first-line treatment, at least in severely affected patients.
Assuntos
Cardiomiopatia Dilatada/fisiopatologia , Doenças Hereditárias Autoinflamatórias/fisiopatologia , Isquemia/fisiopatologia , Insuficiência de Múltiplos Órgãos/fisiopatologia , Choque Cardiogênico/fisiopatologia , Anticorpos Monoclonais Humanizados/uso terapêutico , COVID-19 , Cardiomiopatia Dilatada/diagnóstico por imagem , Cardiomiopatia Dilatada/terapia , Criança , Glucocorticoides/uso terapêutico , Doenças Hereditárias Autoinflamatórias/diagnóstico , Doenças Hereditárias Autoinflamatórias/genética , Doenças Hereditárias Autoinflamatórias/terapia , Humanos , Isquemia/terapia , Nefropatias/diagnóstico por imagem , Nefropatias/fisiopatologia , Nefropatias/terapia , Hepatopatias/diagnóstico por imagem , Hepatopatias/fisiopatologia , Hepatopatias/terapia , Pneumopatias/diagnóstico por imagem , Pneumopatias/fisiopatologia , Pneumopatias/terapia , Linfadenopatia/diagnóstico por imagem , Linfadenopatia/fisiopatologia , Linfadenopatia/terapia , Masculino , Metilprednisolona/uso terapêutico , Insuficiência de Múltiplos Órgãos/terapia , Proteínas de Transporte de Nucleosídeos/genética , Pulsoterapia , Respiração Artificial , SARS-CoV-2 , Choque Cardiogênico/terapia , Esplenopatias/diagnóstico por imagem , Esplenopatias/fisiopatologia , Esplenopatias/terapia , Dedos do Pé/irrigação sanguínea , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
We present a 44-year-old man with multiple flat papules over a tattoo, diagnosed with acquired verruciform epidermodysplasia (EV). The lesions completely disappeared after 3 sessions of photodynamic therapy (PDT) with topical methyl aminolevulinate. PDT could be considered a treatment of choice in human papillomavirus lesions located over tattoos since it resolves the lesions while preserving the integrity of the design.
Assuntos
Fotoquimioterapia , Tatuagem , Verrugas , Adulto , Humanos , Masculino , Papillomaviridae , Fotoquimioterapia/métodos , Fármacos Fotossensibilizantes/uso terapêutico , Verrugas/tratamento farmacológicoRESUMO
Tattoo complications are an increasing reason for dermatological consultation in recent years, becoming a therapeutic challenge in some cases. We present a case of a suppurative granulomatous reaction in a tattoo resistant to oral antibiotic and topical corticosteroid treatment that resolved after four sessions of photodynamic therapy (PDT) with methyl aminolevulinate, possibly due to its anti-inflammatory and antimicrobial action, with an excellent aesthetic result. We suggest that the clinical utility of PDT may be expanded to treatment of tattoo complications, as well as in cutaneous infections of unknown microorganisms resistant to antibiotics.