Ungual Spitz Nevus: Description of Dermoscopic Data.

Introduction: Spitz nevus is an uncommon, benign melanocytic proliferation that primarily appears on face, trunk or lower extremities of children. This lesion may share clinical and microscopical characteristics with melanoma, making it a diagnostic and management challenge. Case Report: A 13-year old male presented with an asymptomatic chronic dermatosis located on the third left-hand nail. Cutaneous examination revealed a homogeneous dark brown melanonychia which extended up to the cuticle. Upon dermoscopy, longitudinal bands measuring less than 3 mm wide of heterogeneous colors ranging from light to dark brown, and positive Hutchinson's sign were observed. Discussion/Conclusion: We report the second case of a Spitz nevus ungually localized which strongly resembled an ungual melanoma with a positive Hutchinson's sign upon dermoscopy. Describing the infrequent presentation and location of the Spitz nevus poses an opportunity to establish diagnostic and management criteria in the near future.

The great imitator with no diagnostic test: pyoderma gangrenosum.

Pyoderma gangrenosum is a rare, neutrophil-mediated, auto-inflammatory dermatosis that wound care specialists must be prepared to recognise. This condition has clinical features analogous to infectious processes. There is no specific diagnostic test and the diagnosis is usually obtained from exclusion. Its early recognition and proper management with prompt initiation of immunosuppressive therapy are essential to improve the quality of life and the prognosis of patients.

Myopericytoma in an unusual location.

Myopericytoma is a soft-tissue tumor of perivascular cells (pericytes). It is slow-growing, usually asymptomatic, and generally benign, although a malignant variant has been described. The etiology is unknown, but it has been associated with local trauma. The most common location is on the distal extremities. Histologically, it is characterized by a well-circumscribed, non-encapsulated proliferation of spindle shaped cells similar to myofibroblasts with oval nuclei and eosinophilic cytoplasm, arranged in perivascular concentric rings. There are few mitoses and no necrosis is reported. The immunohistochemical analysis is positive for smooth muscle actin and negative or weakly positive for desmin. A low Ki-67 proliferation index is typical. Treatment is surgical excision with free margins. Recurrences after adequate excision are uncommon. We describe a 48-year-old woman with a myopericytoma in an unusual location (next to the inner corner of her left eye) who was treated with surgical excision; there has been no recurrence after 5 years of follow up.

[Characteristics and risk factors for recurrence of cutaneous squamous cell carcinoma with conventional surgery and surgery with delayed intraoperative margin assessment]. / Características del carcinoma epidermoide cutáneo y riesgo para el desarrollo de recidivas con cirugía convencional y cirugía con transoperatorio tardío.

BACKGROUND: Non-melanoma skin cancer includes basal cell carcinoma and squamous cell carcinoma (SCC). Basal cell carcinoma is the most common and least aggressive but in a low percentage of cases, despite appropriate wide surgical margins, it can be aggressive, producing local invasion, recurrences and distance metastasis. SCC has a more aggressive behaviour invading first the skin, the lymph nodes and less frequently produces distance metastasis OBJECTIVE: To identify the characteristics of recurrent SCC and frequency of new SCC after conventional surgical and primary closure or closure delayed until a histological reporting of tumour-free surgical margins, in order to achieve a better surgical option, in our Mexican population. MATERIALS AND METHOD: We reviewed clinical records from the last 10 years, and included those with a diagnosis of SCC. RESULTS: One hundred and fourteen tumours in 103 patients were included. The mean new tumour diagnosis was 32.2 per year; there were 46.6% men and 53.4% women. Age range 19-91, with mean 71.94 years (SD=13.34). The evolution time was from 1-112 months (mean=12 months, SD=2.65). The most affected site was the cheek. In addition, an invasive tumour was reported in 54% in the histopathological study. At 10-year follow-up we found a second SCC in 14 patients and only 4 recurrences, between the 1st and 4th year and 3were treated with delayed closure until margins were tumour-free. CONCLUSION: In this study we demonstrated that delayed closure technique is easy and adaptable in our population in the treatment of SCC, achieving good results with very low recurrences at 10- year follow -up.

Conservative surgical management of in situ subungual melanoma: long-term follow-up

Abstract Subungual melanoma represents 20% of all melanomas in Hispanic population. Here, we report the outcome of 15 patients with in situ subungual melanoma treated with resection of the nail unit with a 5-mm margin without amputation, followed up for 55.93 ± 43.08 months. The most common complications included inclusion cysts and nail spicules. We found no evidence of local or distant recurrences at the last visit of our follow up. Functional outcome was good, with only one patient reporting persistent mild pain. These results support functional, non-amputative surgical management of in situ subungual melanomas.

Conservative surgical management of in situ subungual melanoma: long-term follow-up.

Subungual melanoma represents 20% of all melanomas in Hispanic population. Here, we report the outcome of 15 patients with in situ subungual melanoma treated with resection of the nail unit with a 5-mm margin without amputation, followed up for 55.93 ± 43.08 months. The most common complications included inclusion cysts and nail spicules. We found no evidence of local or distant recurrences at the last visit of our follow up. Functional outcome was good, with only one patient reporting persistent mild pain. These results support functional, non-amputative surgical management of in situ subungual melanomas.

[Trichoepithelioma: a retrospective study 1993-2012 - Dr Manuel Gea González General Hospital]. / Tricoepitelioma: estudio retrospectivo (1993-2012, Hospital General «Dr. Manuel Gea González¼).

BACKGROUND: Trichoepithelioma is a benign follicular tumor, affects young female adults, and has three clinical forms: solitary, multiple, or desmoplastic. Diagnosis represents a clinical challenge for the dermatologist. There are many differential diagnoses, and the most important is basal cell carcinoma because they share histological features. It has good prognosis and therefore treatment is usually for aesthetic purposes, even though it is associated with recurrence. METHODS: This is a retrospective study carried out from January 1993 to December 2012 of all the patients who were diagnosed by histopathology to have trichoepithelioma in the dermatology department of the Dr. Manuel Gea González General Hospital. RESULTS: There were 47 cases, of which 70.2% were female, with an average age of 43.6 years. Solitary trichoepithelioma was the most frequent clinical form (66%) and only three of 14 cases of multiple trichoepithelioma had a positive family history.

[Multiple primary melanoma: a clinical case and review of the literature]. / Melanoma primario múltiple (MMP) sincrónico: caso clínico y revisión de la literatura.

Patients with a first primary melanoma are known to have an increased risk of being diagnosed with another primary melanoma. We present the case of a 42-year-old male patient with multiple primary melanoma who was admitted to the dermatology department at the general hospital "Dr Manuel Gea González" in Mexico City. Incidence, risk factors and prognosis are discussed in this review.

[Eruptive vellus hair cysts: prevalence and clinical features]. / Quistes eruptivos vellosos: prevalencia y características clínicas.

BACKGROUND: The eruptive vellous cyst is a benign clinical entity that arises from the infundibulum of the hair unit, characterized by asymptomatic yellowish or brownish papulocystic lesions. In most cases, chest and extremities are involved. Clinical and epidemiological information in Mexico is scarce. OBJECTIVE: To describe the prevalence and demographic and clinical findings of eruptive vellous hair cysts confirmed by histopatological study. MATERIAL AND METHODS: A descriptive, cross sectional study was performed, including all cases with histological diagnosis of eruptive vellous hair cysts from Hospital General Dr. Manuel Gea González database. RESULTS: Seventeen cases were included, 11.7% of them had familiar history of eruptive vellous hair cysts; the most affected anatomical areas were chest, head and extremities (43.7, 37.5 y 31.2%, respectively). Differential diagnosis with epidermoid cysts and multiple steatocistoma was performed more frequently. The prevalence of our center from 1993-2012 was 1.6%. CONCLUSIONS: The characteristics of our patients are similar to those described elsewhere. In addition, we estimated the real prevalence of this condition. They had a benign course and are a basically cosmetic concern, but represent a chronic and difficult to treat condition.

Assessment of syndecan-1 (CD138) and Ki-67 expression for differentiating keratoacanthoma and squamous cell carcinoma.

BACKGROUND: There is a major controversy over the natural behavior of keratoacanthoma (KA). KAs have been described as benign lesions, but also as variants of squamous cell carcinoma (SCC). Microscopic differentiation between these 2 entities is problematic, and sometimes impossible. Syndecan-1 (CD138) is an adhesion molecule whose expression appears to be inversely correlated with tumor invasiveness. Elevated Ki-67 expression is indicative of a high proliferation index, a feature of malignant tumors. METHODS: Syndecan-1 and Ki-67 expression were assessed in 22 KA skin samples and in 17 SCC skin biopsies. RESULTS: Syndecan-1 expression was diminished in the SCC specimens compared with the KA specimens ( P =.000). Ki-67 expression was increased in the SCC specimens compared with the KA specimens, with mean values of 9 and 0.08, respectively ( P =.000). LIMITATIONS: Further studies that compare intermediate risk KAs to typical KAs and SCCs are required to corroborate these findings. CONCLUSION: The assessment of syndecan-1 and Ki-67 expression in skin biopsies is a helpful tool for differentiating KA and SCC

Dermoscopy Clues in Pigmented Bowen's Disease.

Pigmented tumors have similar clinical features that overlap and hamper diagnosis. Dermoscopy increases the diagnostic accuracy of doubtful melanocytic lesions and has been used as a noninvasive tool in the detection of pigmented lesions (PLs) like melanoma, basal cell carcinoma, and pigmented Bowen's disease (pBD). Our objective was to show the dermoscopic features of 2 cases of pBD and compare with the findings reported in the literature. Two dermoscopic images of biopsy proven pBD were retrospectively analyzed for dermoscopic patterns. Both cases showed brown regular globules, structureless brown and blue pigmentation, glomerular vessels, hypopigmented regression-like areas, and keratosis. These findings were similar to the cases reported previously. The dermoscopic diagnosis of pBD is based on the absence of criteria for a melanocytic lesion in the presence of glomerular vessels, regular brown globules and keratosis. Although pBD is rare, it should be included in the differential diagnosis of PLs, especially melanoma.

Melanonychia, melanocytic hyperplasia, and nail melanoma in a Hispanic population.

OBJECTIVE: Longitudinal melanonychia (LM) is a common dermatologic problem encountered in everyday practice. Its diagnostic approach is critical as it can be an early sign of nail melanoma. Racial melanonychia is the entity most frequently associated with LM. Because there are no clinical data regarding these associations in a Mexican population, we conducted a prospective study. METHODS: A total of 68 consecutive patients given the clinical diagnosis of LM were included and a nail biopsy was performed to determine its cause. RESULTS: Racial melanonychia was found in 48 cases (68%), 4 cases (5.7%) were associated with benign melanocytic hyperplasia, and 4 cases (5.7%) had a nail apparatus malignancy. LIMITATIONS: Dermatoscopy and immunohistochemical stains were not used. Incisional transverse nail matrix biopsies were performed when melanonychia affected the middle portion of the nail plate. CONCLUSION: LM is most commonly associated with racial melanonychia in the Mexican population, but in nearly 6% of cases it may be linked with nail apparatus malignancy. To our knowledge, this is the first time a study of this nature was performed in a mestizo Hispanic population.

Nail unit tumors: a study of 234 patients in the dermatology department of the "Dr Manuel Gea González" General Hospital in Mexico City.

BACKGROUND: The frequency of nail unit tumors is not well known because they are often misdiagnosed, and the clinical appearance of benign and malignant tumors is not characteristic. PATIENTS AND METHODS: A total of 234 patients from the dermatology department of a general hospital in Mexico City were included in this study, from January 1982 to November 2006. RESULTS: The tumors most frequently diagnosed were fibrous tumors (29.05%), osteocartilaginous tumors (21.79%), and myxoid pseudocysts (11.96%). Malignant melanoma occupied the fourth place (9.82%), and the second most frequent malignant tumor was squamous cell carcinoma (SCC; 4.70%). Among other tumors were glomus, neurofibromas, giant cell tumors of tendon sheath, and pyogenic granulomas. The nail plate was affected in 46.5% of the cases studied. CONCLUSION: This study in a Mexican population sheds light on the frequency and the alterations produced by nail unit tumors, which we must keep in mind for a more accurate diagnosis.

[Confluent and reticulated Gougerot-Carteaud papillomatosis: a case report of an excellent response to minocycline]. / Papilomatosis reticulada y confluente de Gougerot-Carteaud. Un caso con excelente respuesta a minociclina.

Confluent and reticulated Gougerot-Carteaud papillomatosis is an uncommon dermatological condition that affects adolescents, especially young women with dark skin types. It presents itself as asymptomatic pigmented patches with a papillomatous texture that coalesce to form reticular plaques localized in the neck and intertriginous areas. The cause of this disease is unknown, although an abnormal keratinization has been implicated and sometimes has been associated with Malassezia sp. It has a chronic course with remissions and exacerbations. Several therapies have been used unsuccessfully to eradicate it but nowadays there is no specific treatment. We report a case treated efficiently with minocycline without recurrence at 6 months follow-up.

Papilomatosis reticulada y confluente de Gougerot-Carteaud: un caso con excelente respuesta a minociclina / Confluent and reticulated Gougerot-Carteaud papillomatosis: a case report of an excellent response to minocycline

La papilomatosis reticulada y confluente de Gougerot-Carteaud es una dermatosis poco frecuente que por lo general afecta a individuos jóvenes, especialmente a mujeres de fototipos oscuros. Es asintomática y se presenta como placas pigmentadas con textura papilomatosa que confluyen formando placas reticuladas de mayor tamaño en el cuello y zonas intertriginosas. La causa es desconocida, aunque se ha implicado una queratinización anormal, y en ocasiones se puede asociar a Malassezia sp. Su evolución es crónica con remisiones y exacerbaciones. Por el momento no se dispone de un tratamiento específico. Se presenta un caso tratado de manera efectiva con minociclina que no presentó recidiva tras seis meses de seguimiento.

Confluent and reticulated Gougerot-Carteaud papillomatosis is an uncommon dermatological condition that affects adolescents, especially young women with dark skin types. It presents itself as asymptomatic pigmented patches with a papillomatous texture that coalesce to form reticular plaques localized in the neck and intertriginous areas. The cause of this disease is unknown, although an abnormal keratinization has been implicated and sometimes has been associated with Malassezia sp. It has a chronic course with remissions and exacerbations. Several therapies have been used unsuccessfully to eradicate it but nowadays there is no specific treatment. We report a case treated efficiently with minocycline without recurrence at 6 months follow-up.

Frecuencia de tumores benignos durante el periodo de 2000-2006 en el Hospital General Dr. Manuel Gea González / Frequency of benign tumors at the Hospital General Dr. Manuel Gea Gonzalez: record review between 2000-2006

Antecedentes: Los tumores benignos de la piel se definen como el crecimiento autónomo de tejido sin relación con el patrón normal de crecimiento tisular, que persiste después del estímulo que le dio origen. Prácticamente todos los humanos presentan algún tumor benigno, pero la mayoría de las veces no se busca atención ya que no producen molestias. Son escasos los registros sobre la frecuencia de los tumores benignos. El objetivo de este estudio fue informar el número de tumores benignos en el Departamento de Dermatología de nuestro hospital. Material y métodos: Se realizó un estudio retrospectivo en el que se revisaron los registros de histopatología del periodo 2000 a 2006. Se registró año, número de biopsia, sexo, edad, topografía, diagnóstico clínico y diagnóstico histológico. Resultados: Se analizaron 9436 registros de biopsias, de las cuales 3765 fueron tumores benignos, de éstos se eliminaron 595 biopsias por falta de datos, para un total de 3170. Los tumores más frecuentes por grupo histopatológico en forma descendente fueron los tumores melanocíticos, quistes, tumores fibrosos, vasculares, de la epidermis, de tejido adiposo, del pelo, neurales, glandulares, sebáceos, de cartílago y hueso, y de músculo liso. Los tumores más frecuentes en general fueron nevos melanocíticos, quistes epidermoides, queratosis seborreicas, granulomas piógenos, lipomas y dermatofibromas. Conclusiones: Los tumores benignos más frecuentes fueron los melanocíticos constituidos por nevos de unión, intradérmicos y compuestos, y los quistes epidermoides. Esta serie proporciona información de los tumores benignos más comunes en un servicio dermatológico.

BACKGROUND: Benign skin neoplasms are defined as autonomous growing tissue unrelated to normal growing of the skin, that persist even after the originating stimulus dissapears. Almost all human beings have a certain number of benign cutaneous neoplasms and many never seek medical attention. There is a dearth of information regarding the frequency of these tumors. The aim of this study was to record the number of benign tumors studied at the Dermatology Department of a medical facility. MATERIAL AND METHODS: A retrospective study analyzed medical records between 2000 and 2006. We included year of admission, number of biopsies, sex, age, tumor location, histological and clinical diagnoses. RESULTS: We analyzed 9,436 biopsies of which 3,765 constituted benign neoplasms; 595 were not included and our total sample was 3,170 tumors. The most frequent tumors according to histopathological diagnoses in descending order were: melanocytic, cutaneous cysts, fibrous tumors, vascular tumors, epidermal tumors, fat tumors, tumors with hair differentiation, neural tumors, glandular tumors, tumors with sebaceous differentiation, cartilage and bone tumors, and smooth muscle tumors. The most common benign tumors were: Melanocytic nevi, epidermal cysts, seborrheic keratoses, pyogenic granulomas, lipomas and dermatofibromas. CONCLUSIONS: Melanocytes represented by melanocytic nevi (junctional, intradermic and compound) were the most frequent benign neoplasms, followed by epidermoid cysts. Our results illustrate the most common benign tumors observed in a dermatology department.

[Frequency of benign tumors at the Hospital General "Dr. Manuel Gea Gonzalez". Record review between 2000-2006]. / Frecuencia de tumores benignos durante el periodo de 2000-2006 en el Hospital General "Dr. Manuel Gea González".

BACKGROUND: Benign skin neoplasms are defined as autonomous growing tissue unrelated to normal growing of the skin, that persist even after the originating stimulus dissapears. Almost all human beings have a certain number of benign cutaneous neoplasms and many never seek medical attention. There is a dearth of information regarding the frequency of these tumors. The aim of this study was to record the number of benign tumors studied at the Dermatology Department of a medical facility. MATERIAL AND METHODS: A retrospective study analyzed medical records between 2000 and 2006. We included year of admission, number of biopsies, sex, age, tumor location, histological and clinical diagnoses. RESULTS: We analyzed 9,436 biopsies of which 3,765 constituted benign neoplasms; 595 were not included and our total sample was 3,170 tumors. The most frequent tumors according to histopathological diagnoses in descending order were: melanocytic, cutaneous cysts, fibrous tumors, vascular tumors, epidermal tumors, fat tumors, tumors with hair differentiation, neural tumors, glandular tumors, tumors with sebaceous differentiation, cartilage and bone tumors, and smooth muscle tumors. The most common benign tumors were: Melanocytic nevi, epidermal cysts, seborrheic keratoses, pyogenic granulomas, lipomas and dermatofibromas. CONCLUSIONS: Melanocytes represented by melanocytic nevi (junctional, intradermic and compound) were the most frequent benign neoplasms, followed by epidermoid cysts. Our results illustrate the most common benign tumors observed in a dermatology department.

[Mammary Paget's disease: case report and review of the literature]. / Enfermedad de Paget mamaria: comunicación de un caso y revisión de la literatura.

Paget's disease of the nipple is a superficial manifestation of an underlying breast malignancy. It has been reported in 1-3% of all breast carcinomas. The peak incidence is between 50 and 60 years. Its clinical presentation includes an unilateral, erythematous, slightly infiltrated scaly plaque and nipple retraction. Sero-sanguineous discharge may be observed. We here report a 51 year old woman who had an eight month history of an eritematous-squamous plaque with hematic scabs in the left nipple, with mild pruritus. A biopsy was taken and the diagnosis confirmed Paget's disease and intraductal breast carcinoma.