RESUMEN
BACKGROUND: Evidence regarding long-term therapeutic outcomes and disease-specific survival (DSS) in Extramammary Paget's disease (EMPD) is limited. OBJECTIVES: To assess the DSS and outcomes of surgical and nonsurgical therapeutic modalities in a large cohort of EMPD patients. METHODS: Retrospective chart review of EMPD patients from 20 Spanish tertiary care hospitals. RESULTS: Data on 249 patients with a median follow-up of 60 months were analyzed. The estimated 5-, 10-, and 15-year DSS was 95.9%, 92.9%, and 88.5%, respectively. A significantly lower DSS was observed in patients showing deep dermal invasion (≥1 mm) or metastatic disease (P < .05). A ≥50% reduction in EMPD lesion size was achieved in 100% and 75.3% of patients treated with surgery and topical therapies, respectively. Tumor-free resection margins were obtained in 42.4% of the patients after wide local excision (WLE). The 5-year recurrence-free survival after Mohs micrographic surgery (MMS), WLE with tumor-free margins, WLE with positive margins, radiotherapy, and topical treatments was 63.0%, 51.4%, 20.4%, 30.1%, and 20.8%, respectively. LIMITATIONS: Retrospective design. CONCLUSIONS: EMPD is usually a chronic condition with favorable prognosis. MMS represents the therapeutic alternative with the greatest efficacy for the disease. Recurrence rates in patients with positive margins after WLE are similar to the ones observed in patients treated with topical agents.
Asunto(s)
Enfermedad de Paget Extramamaria , Humanos , Estudios Retrospectivos , Enfermedad de Paget Extramamaria/cirugía , Cirugía de Mohs , Análisis de Supervivencia , Márgenes de Escisión , Resultado del Tratamiento , Recurrencia Local de Neoplasia/epidemiología , Recurrencia Local de Neoplasia/terapia , Recurrencia Local de Neoplasia/patologíaRESUMEN
BACKGROUND: Topical imiquimod has shown to be an effective treatment for EMPD, although available evidence supporting its use is based on case reports and small series of patients. OBJECTIVES: To investigate the therapeutic outcomes and analyze potential clinico-pathological factors associated with imiquimod response in a large cohort of EMPD patients. METHODS: Retrospective chart review of 125 EMPD patients treated with imiquimod at 20 Spanish tertiary-care hospitals. RESULTS: During the study period, patients received 134 treatment regimens with imiquimod, with 70 (52.2%) cases achieving complete response (CR), 41 (30.6%) partial response and 23 (17.2%) no response. The cumulative CR rates at 24 and 48 weeks of treatment were 46.3% and 71.8%, respectively, without significant differences between first-time and previously treated EMPD. Larger lesions (≥6â cm; p = 0.038) and EMPD affecting >1 anatomical site (p = 0.002) were significantly associated with a worse treatment response. However, the CR rate did not differ significantly by the number of treatment applications (≤4 vs. > 4 times/week; p = 0.112). Among patients who achieved CR, 30 (42.9%) developed local recurrences during a mean follow-up period of 36â months, with an estimated 3 and 5-year recurrence free-survival of 55.7% and 36.4%, respectively. CONCLUSIONS: Imiquimod appears as an effective therapeutic alternative for both first-line and previously treated EMPD lesions. However, a less favorable therapeutic response could be expected in larger lesions and those affecting >1 anatomical site. Based on our results, a 3-4 times weekly regimen of imiquimod with a treatment duration of at least 6â months could be considered an appropriate therapeutic strategy for EMPD patients.
RESUMEN
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.
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Carcinoma de Células Escamosas , Neoplasias Cutáneas , Humanos , Carcinoma de Células Escamosas/patología , Estudios de Cohortes , Estudios Retrospectivos , Pronóstico , Neoplasias Cutáneas/patología , Recurrencia Local de Neoplasia/epidemiología , Recurrencia Local de Neoplasia/patología , Factores de Riesgo , Recurrencia , Estadificación de NeoplasiasRESUMEN
The external ear is a crucial part of the ear's anatomy for both functional and aesthetic purposes. We present a defect after the extirpation of an invasive squamous cell carcinoma, where the final defect involved the superior third of the outer ear, missing both cartilage and skin. The regional chondrocutaneous composite transposition flap of the ipsilateral auricular concha is a one-stage technique that successfully preserves the helical rim's shape and size.
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Pabellón Auricular , Neoplasias del Oído , Procedimientos de Cirugía Plástica , Humanos , Neoplasias del Oído/cirugía , Colgajos Quirúrgicos , Oído Externo/cirugía , Pabellón Auricular/cirugíaRESUMEN
Cutaneous cancers are, by far, the most common malignant neoplasms of the human being. Due to the great array of clinical conditions, their worldwide increasing incidence and the steady ageing of the population, non-invasive treatments modalities that show a good clinical response, a proper benefit-risk ratio and cosmetic results are becoming increasingly important in the clinical setting. Imiquimod is a topically applied immunomodulator which is often used in the management of several premalignant and malignant cutaneous disorders. This article is a review of the current literature on its mechanism of action, pharmacokinetics, and therapeutical effects.
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Antineoplásicos , Lesiones Precancerosas , Neoplasias Cutáneas , Humanos , Imiquimod/uso terapéutico , Neoplasias Cutáneas/tratamiento farmacológico , Neoplasias Cutáneas/epidemiología , Adyuvantes Inmunológicos/uso terapéutico , Piel/patología , Lesiones Precancerosas/tratamiento farmacológico , Administración Cutánea , Inmunoterapia , Aminoquinolinas/farmacología , Aminoquinolinas/uso terapéutico , Antineoplásicos/farmacología , Antineoplásicos/uso terapéuticoRESUMEN
The COVID-19 pandemic led to a decrease in the number of operating rooms available. Single-stage islanded forehead flaps have emerged as a good alternative to the classic frontal flap helping to diminish the surgical waiting list. We present our case series of 6 patients reconstructed with islanded forehead flaps between February and July 2020.The purpose of this report is to assess the advantages and disadvantages of this technique in order to inform which subgroup of patients may benefit from the one-stage flap, now the pandemic is better controlled.
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COVID-19 , Rinoplastia , Frente , Humanos , Nariz/cirugía , Pandemias , Rinoplastia/métodosAsunto(s)
Neoplasias Cutáneas , Piel , Humanos , Neoplasias Cutáneas/cirugía , Instrumentos Quirúrgicos , Técnicas de Sutura , SuturasRESUMEN
Fibro-osseous pseudotumor of the digits is a benign neoplasm that originates in the soft tissue adjacent to the short bones of the hands and feet. We present a case in a 13-year-old girl that was initially misdiagnosed as pyogenic granuloma. Familiarity with this entity and imaging and histologic studies are necessary to avoid incorrect diagnoses and aggressive surgical interventions.
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Fibroma/patología , Granuloma de Células Plasmáticas/patología , Granuloma Piogénico/patología , Osteoma/patología , Neoplasias de los Tejidos Blandos/patología , Adolescente , Biopsia con Aguja , Diagnóstico Diferencial , Femenino , Fibroma/diagnóstico , Fibroma/cirugía , Dedos , Granuloma de Células Plasmáticas/diagnóstico , Granuloma Piogénico/diagnóstico , Humanos , Inmunohistoquímica , Osteoma/diagnóstico , Osteoma/cirugía , Enfermedades Raras , Neoplasias de los Tejidos Blandos/diagnóstico , Neoplasias de los Tejidos Blandos/cirugía , Resultado del TratamientoAsunto(s)
Erupciones por Medicamentos , Sofosbuvir , Antivirales/efectos adversos , Carbamatos/efectos adversos , Combinación de Medicamentos , Erupciones por Medicamentos/tratamiento farmacológico , Quimioterapia Combinada , Genotipo , Compuestos Heterocíclicos de 4 o más Anillos/efectos adversos , Humanos , Sofosbuvir/efectos adversos , Resultado del TratamientoAsunto(s)
Pérdida de Sangre Quirúrgica/prevención & control , Neoplasias de Cabeza y Cuello/cirugía , Hemorragia Posoperatoria/prevención & control , Cuidados Preoperatorios/métodos , Cuero Cabelludo , Neoplasias Cutáneas/cirugía , Técnicas de Sutura , Humanos , Hemorragia Posoperatoria/epidemiología , Medición de RiesgoAsunto(s)
Neoplasias de Cabeza y Cuello/cirugía , Hemostasis Quirúrgica/instrumentación , Cirugía de Mohs/métodos , Hemorragia Posoperatoria/prevención & control , Neoplasias Cutáneas/cirugía , Craneotomía/instrumentación , Neoplasias de Cabeza y Cuello/diagnóstico , Humanos , Cirugía de Mohs/efectos adversos , Cirugía de Mohs/instrumentación , Hemorragia Posoperatoria/etiología , Cuero Cabelludo/patología , Cuero Cabelludo/cirugía , Piel/patología , Neoplasias Cutáneas/diagnóstico , Neoplasias Cutáneas/patología , Resultado del TratamientoAsunto(s)
Inhibidores de la Angiogénesis/efectos adversos , Exantema/inducido químicamente , Lenalidomida/efectos adversos , Protocolos de Quimioterapia Combinada Antineoplásica , Receptores ErbB/antagonistas & inhibidores , Humanos , Masculino , Persona de Mediana Edad , Mieloma Múltiple/tratamiento farmacológicoRESUMEN
Background: Squamous cell carcinoma (SCC) arising in a sacrococcygeal pilonidal sinus is rare, with cases of metastatic disease being even rarer. Among published cases, almost none have reported on systemic treatment. Objective: This disease has a poorer prognosis than other forms of cutaneous SCC; therefore, our objective is to shed some light on the treatment of metastatic disease. Methods: We present a series of nine cases treated at a single center, four of whom received systemic treatment. Additionally, other previously reported cases of metastatic disease are included in an attempt to draw stronger conclusions. Results: Four patients were treated under several treatment regimens, with a median progression-free survival of only 2 months and two instances of partial response (18%). The best result was achieved with cemiplimab. Across all the cases, there was a trend toward a benefit of the use of systemic treatment (HR 0.41, 95% CI 0.15-1.12, p = 0.083; median overall survival 13 vs. 8 months). Limitations: Limitations include the significant lack of information on previously published cases and the extremely heterogeneous nature of the existing information. Conclusion: The initial systemic treatment should be an anti-PD-1, as with other SCCs. After progression on anti-PD-1, there is no strong evidence to support the recommendation of a specific treatment or sequence: options include cetuximab and/or chemotherapy (platinum, paclitaxel, 5-fluorouracyl).