[Initial evaluation, diagnosis, staging, treatment, and follow-up of patients with primary cutaneous malignant melanoma. Consensus statement of the Network of Catalan and Balearic Melanoma Centers]. / Valoración inicial, diagnóstico, estadificación, tratamiento y seguimiento de los pacientes con melanoma maligno primario de la piel. Documento de consenso de la "Xarxa de Centres de Melanoma de Catalunya i Balears"

The consensus statement on the management of primary cutaneous melanoma that we present here was based on selection, discussion, review, and comparison of recent literature (including national and international guidelines). The protocols for the diagnosis, treatment, and follow-up used in the hospital centers throughout Catalonia and the Balearic Isles belonging to the Network of Catalan and Balearic Melanoma Centers were also considered. The main objective of this statement was to present the overall management of melanoma patients typically used in our region at the present time. As such, the statement was not designed to be an obligatory protocol for health professionals caring for this group of patients, and neither can it nor should it be used for this purpose. Professionals reading the statement should not therefore consider it binding on their practice, and in no case can this text be used to guarantee or seek responsibility for a given medical opinion. The group of dermatologists who have signed this statement was created 3 years ago with the aim of making our authorities aware of the importance of this complex tumor, which, in comparison with other types of cancer, we believe does not receive sufficient attention in Spain. In addition, the regular meetings of the group have produced interesting proposals for collaboration in various epidemiological, clinical, and basic applied research projects on the subject of malignant melanoma in our society.

Tegafur-induced acral hyperpigmentation.

Four patients with colorectal cancer treated with tegafur (a fluoropyrimidine structurally similar to 5-fluorouracil) noted a macular, spotted hyperpigmentation limited to the palms, soles, nails, and glans penis. Histopathologic examination disclosed epidermal basal hyperpigmentation with a lentiginous pattern. Mucocutaneous lesions resolved spontaneously two months after treatment was discontinued. This peculiar phenomenon seems to represent a previously unreported side effect of this cytotoxic drug.

[Stevens-Johnson syndrome after lamotrigine treatment]. / Sídrome de Stevens-Johnson tras la introducción de lamotrigina.

We report a 18 years old female with Lennox-Gastaut syndrome under treatment with sodium valproate, carbamazepine and clonazepam. When seizures increased we stopped carbamazepine and introduced lamotrigine slowly. One month later the girl developed haemorrhagic erosions in mucoses and limbs with deterioration of her general state. Skin biopsy confirmed the diagnosis of erythema multiforme, the Stevens-Johnson's form. The immediate withdrawal of lamotrigine and treatment with antihystaminics and steroids was followed of a slowly favourable course with disappearance of symptomatology one month later. It's another case of Stevens-Johnson syndrome related to the introduction of lamotrigine in polytherapy.

[Spreading pigmented actinic keratosis]. / Queratosis actínica pigmentada centrífuga.

Two cases of spreading pigmented actinic keratosis are reported. In case number one, an invasive, pigmented squamous cell carcinoma developed in the lesion. Clinicopathologic features include size greater than normal, lateral spread of the lesion, and presence of melanin in dysplastic epidermal cells, dendritic melanocytes and dermal melanophages. Differential diagnosis to be considered includes lentigo maligna, lentigo maligna melanoma and seborrheic keratosis.

[Fibroma of the tendon sheath]. / Fibroma de la vaina tendinosa.

Fibroma of the tendon sheath (FTS) is a rare benign soft tissue tumor. Its location and clinical findings may be similar to the giant cell tumor of tendon sheath or to infantile digital fibromatosis. Accurate diagnosis of FTS depends on microscopic examination of the excised tumor. The present report deals with two cases.

Lipodystrophia centrifugalis abdominalis infantilis: a case report.

We describe a typical case of lipodystrophia centrifugalis abdominalis infantilis. This rare disorder is almost exclusively seen in Japanese children. The patient, a 3-year-old girl of Chinese ancestry, had a depressed area of skin in the right groin which gradually spread across the abdomen. The lesion had a distinctive, slightly erythematous, raised border and regional lymphadenopathy was present.

Cutaneous angiomas in POEMS syndrome.

POEMS syndrome is an unusual plasma cell dyscrasia with multisystemic manifestations featuring polyneuropathy, organomegaly, endocrinopathy, M protein and constant skin involvement. We have seen a 58-year-old white man presenting with generalized eruptive angiomas as a rare skin manifestation of this syndrome. We review the literature and discuss the pathogenesis of vascular proliferation in this unusual entity.

Granulation tissue proliferation during isotretinoin treatment.

Excessive, pseudotumoral granulation tissue proliferations appeared in three patients receiving isotretinoin for nodulocystic acne. A review of the literature disclosed few reports of this unusual adverse reaction. Two clinical patterns have been reported; one in a periungual location and the other occurring in the sites of acne lesions during isotretinoin therapy. Loose edematous connective tissue with small vessels and chronic inflammatory infiltrate were the histologic findings in all three cases.

Malignant hidroacanthoma simplex. A light microscopic, ultrastructural, and immunohistochemical study of 2 cases.

2 cases of malignant hidroacanthoma simplex are reported. Prominent ultrastructural findings were sparse tonofilaments and villous-like, interdigitating cytoplasmic processes connected by small desmosomes. Positive intracytoplasmic stain for carcinoembryonic antigen was found in 1 case. Benign and malignant eccrine poromas and hidroacanthoma simplex appear to be related neoplasms on the basis of ultrastructural and immunohistochemical findings.

Panniculitis in Pseudomonas aeruginosa septicemia.

A 71-year-old man developed multiple subcutaneous nodules during Pseudomonas aeruginosa septicemia. The acute and simultaneous flare of inflammatory nodules in a septic patient appears to be rather specific in Pseudomonas infections. Histological vascular lesions are prominent in the subcutaneous nodules.

Verrucous hemangioma.

Verrucous hemangioma is an infrequent variety of deep-seated capillary or cavernous hemangioma with reactive epidermal hyperplasia and a superficial component indistinguishable from those of angiokeratoma. Four cases of verrucous hemangioma are reported herein. Verrucous hemangiomas are usually congenital lesions which do not resolve spontaneously and have a tendency to recur after excision if margins are inadequate. Careful histopathologic and clinical evaluation are required for an optimal therapeutic approach.

Disseminated, miliarial type lymphocytoma cutis. A report of two cases.

The disseminated, miliarial type of lymphocytoma cutis (DMLC) is a clinicopathologic subtype of lymphocytoma, characterized by multiple, 1-2 mm translucent asymptomatic papules located in the exposed areas of the head and neck. DMLC represents a multifocal hyperplasia of B-lymphocytes with follicular differentiation and formation of follicular germinal centres. The evolution of the disease is characteristic, with some of the lesions resolving and other progressing to nodules or pseudolymphomas. The disease has a chronic course, with complete resolution in one to several years.

Invisible mycosis fungoides: A diagnostic challenge.

We describe a 76-year-old woman who presented persistent generalized pruritus as the only cutaneous manifestation of a cutaneous T-cell lymphoma (mycosis fungoides). No cutaneous lesions were observed throughout the patient's course. Skin biopsies obtained from normal-looking pruritic skin revealed a discrete perivascular lymphocytic infiltrate in the upper dermis and focal intraepidermal clusters of atypical lymphoid cells (Pautrier's microabscesses). PCR analysis of TCR-gamma gene disclosed a monoclonal T-cell rearrangement. Sequencing of the PCR monoclonal product identified the J(8)V(2)C(2) TCR gene rearrangement. This observation illustrates the existence of a peculiar and exceedingly rare form of mycosis fungoides characterized only by persistent pruritus unresponsive to several therapeutic approaches. The diagnostic difficulties of this rare variant are stressed.