Do not PASS any melanoma without diagnosis: a new simplified dermoscopic algorithm.

INTRODUCTION: Dermoscopic algorithms for melanoma diagnosis could be time-expending, and their reliability in daily practice lower than expected. OBJECTIVE: To propose a simplified dermoscopic algorithm for melanoma diagnosis. MATERIAL AND METHODS: A multicenter retrospective analysis of 1,120 dermoscopic images of atypical melanocytic tumors (320 melanomas and 800 non-melanomas) was performed. An algorithm based on polychromia, asymmetry in colors or structures, and some melanoma-specific structures was designed. Univariate and multivariate logistic regression analysis was calculated to estimate the coefficients of each potential predictor for melanoma diagnosis. A score was developed based on the dermoscopic evaluations performed by four experts blinded to histological diagnosis. RESULTS: Most melanomas had ≥3 colors (280; 84.5%), asymmetry in colors or structures (289; 90.3%), and at least one melanoma-specific structure (316; 98.7%). PASS score ≥3 had a 91.9% sensibility, 87% specificity, and 88.4% diagnostic accuracy for melanoma. PASS algorithm showed an area under the curve (AUC) of 0.947 (95% CI 0.935-0.959). LIMITATIONS: This study was retrospective. A comparison between the performances of different dermoscopic algorithms is difficult because of their designs. CONCLUSION: PASS algorithm showed a very good diagnostic accuracy, independently of the observers' experience, and it seems easier to perform than previous dermoscopic algorithms.

Melanocortin 1 receptor variants and their association with phenotypic characteristics and sporadic multiple primary melanomas in a cohort of 402 Spanish subjects.

The melanocortin 1 receptor (MC1R) gene is considered to be a major determinant of the risk of melanoma. The role of MC1R polymorphisms as predisposing factors for the development of a second primary melanoma is not well established. The present study analyses the characteristics from subjects with certain MC1R variants without any other genetic predisposition, as well as the risk of second primary melanoma associated with these variants. We performed a prospective longitudinal single-centre study based on follow-up information of 402 patients diagnosed with cutaneous melanoma. MC1R gene was sequenced in all subjects. High-risk variants were defined as those previously associated with melanoma (V60L, V92M, I155T, R160W, R163Q and D294H). 253 (63%) patients had at least one predisposing variant. These individuals had higher proportion of red/blonde hair, multiple primary melanomas and first melanoma diagnosis under the age of 60. Second primary melanomas were detected in 28 (3.8%) subjects. Having more than 25 melanocytic nevi was associated significantly to the development of second primary melanomas. A higher proportion of individuals carrying at least one predisposing MC1R variant develop a second melanoma, although statistical significance was not reached. Therefore, some MC1R polymorphisms might determine clinical and histological differences between patients with cutaneous melanoma and may represent a risk factor for second primary melanoma, although more studies are needed.

Who detects melanoma? Impact of detection patterns on characteristics and prognosis of patients with melanoma.

BACKGROUND: Despite the importance of early diagnosis, patients with cutaneous melanoma often seek consultation at advanced stages of the disease. The impact on prognosis according to who first detects the primary tumor has not been established. OBJECTIVE: This study aims to determine who first detects melanoma, the reasons that patients with melanoma consult a doctor, and the impact of detection patterns on the characteristics and prognosis of melanoma. METHODS: Seven hundred eighty-three patients with cutaneous melanoma who were diagnosed between 1996 and 2012 were included. Associations between who first noticed the melanoma (ie, self-detected, relatives, health care workers, or dermatologists), epidemiology, clinical presentation, histology, and patient outcomes were analyzed. RESULTS: Most melanomas were self-detected (53%). Among these patients, 32% consulted because of bleeding, itching/pain, or nodule enlargement. There were more melanomas self-detected among women than among men, and these had a better prognosis. Men had significantly more melanomas on non-easily visible locations than women did. Among melanomas noticed by dermatologists, 80% were incidental findings. Self-detected melanomas were thicker and more frequently ulcerated, developed metastases more often, and were associated with more melanoma-related deaths. CONCLUSIONS: Patients with melanomas detected by dermatologists had better prognoses than patients with self-detected melanomas. Patients with melanomas that were self-detected by women had better prognoses than those that were self-detected by men, especially for patients >70 years of age. This group might therefore be a logical target for melanoma detection education.

Histological ulceration as a prognostic factor in cutaneous melanoma: a study of 423 cases in Spain.

INTRODUCTION: Histological ulceration in cutaneous melanoma carries a high risk of metastasis and has a poor prognosis. However, some epidemiological and survival studies of patients with cutaneous melanoma do not consider histological ulceration as one of the main prognostic factors. MATERIALS AND METHODS: Epidemiological, clinical, histological and survival characteristics of all patients diagnosed with cutaneous melanoma over a 10-year period (1994- 2003) were retrospectively analysed. RESULTS: Ulcerated melanoma was observed in 77 of 423 patients (18.2%). Ulceration was significantly associated with male sex, deeper tumour thickness, positive sentinel lymph node biopsy and metastasis (p<0.001). Histological ulceration indicates a high relative risk (RR) of death from melanoma (RR 9.41; 95% CI 4.52-19.59) and a significant risk of metastasis (RR 5.72; 95% CI 3.56-9.19) (p<0.001). CONCLUSIONS: Histological ulceration is associated with lower overall survival and disease-free survival in patients with cutaneous melanoma. Presence of ulceration must be included in the clinical history of patients with melanoma to ensure a careful diagnostic work-up and follow-up.

Acral cutaneous melanoma in a Spanish Caucasian population.

Acral lentiginous melanoma (ALM) is the most frequent type of cutaneous melanoma in the Asian and African populations, but the fourth distinct variant of cutaneous melanoma in the Caucasian population. Histological criteria and prognosis of ALM remain controversial. A retrospective study, showing epidemiological, clinical, histological and survival characteristics of melanomas located on acral sites (acral cutaneous melanoma) compared with nonacral melanomas. Fifty-two of 552 melanomas (9.42%) were located on acral sites. Histological examination revealed ALMs in 30 cases (61%), nodular melanomas in seven cases (14.3%) and superficial spreading melanomas in five cases (10.2%). Patients with ulcerated melanomas had an older mean age (62.3 vs. 57.2 years) (P=0.02). Tumour thickness was greater in acral melanomas (2.8 vs. 1.9 mm) (P=0.039). Overall survival and disease-free survival did not differ significantly from melanomas on other sites. Acral cutaneous melanoma has peculiar epidemiological features in the Spanish population. They are more frequent in patients above 65 years of age and they have a greater tumour thickness, but they are not significantly associated with a lower survival.

Risk factors in pediatric dermatologic surgery.

BACKGROUND: Specific risk factors for complications in pediatric dermatologic surgery have not been studied in previous reports. OBJECTIVES: Analyze complications of a cohort of children for anesthetic and surgical complications and determine specific risk factors for surgical complications. METHODS: Retrospective collection of data from 210 consecutive children having operations over 6 years. Bivariate and logistic regression statistical analysis of complications and risk factors was conducted for single step interventions. RESULTS: General anesthesia complications were observed in 10.07 percent of the cases: Agitation and stridor were the most common anesthetic complications. Surgical complications were observed in 22.63 percent of the cases. Scar stretching followed by infection were the most prevalent complications. Complication rates, both anesthetic (9.09%) and surgical (13.63%) of multiple step interventions were similar to single step surgery. Intradermal absorbable suture in upper closure (p=0.028) and in limb (p=0.014) location were independently associated with complications. CONCLUSION: General anesthesia is safe in pediatric dermatology in the hands of experienced pediatric anesthetists. The most frequent surgical complication was scar stretching. Limb location and use of absorbable continuous intradermal suture in the upper closures should be taken into account as possible risk factors when informing parents and performing these procedures.

Epidemiología y supervivencia del melanoma cutáneo en España: estudio de 879 casos (1991-2007) / Epidemiology and survival of cutaneous melanoma in Spain: a 879 cases report (1991-2007)

Introducción: La incidencia del melanoma cutáneo ha aumentando durante las últimas décadas en todo el mundo. Los trabajos sobre epidemiología y supervivencia de los pacientes diagnosticados de melanoma en nuestro país son escasos. Material y métodos: Se obtuvieron de forma retrospectiva los datos referentes a todos los pacientes diagnosticados de melanoma cutáneo durante un período de 17 años (1991-2007) en el Hospital General Universitario ®Gregorio Marañón¼ de Madrid. Resultados: Se describen las características epidemiológicas, clínicas e histopatológicas de 879 melanomas, así como la evolución de estos pacientes. Se analizan los posibles factores con influencia en la supervivencia global y en la aparición de metástasis o tiempo libre de enfermedad. Discusión: La incidencia de melanoma en nuestra población se ha duplicado en la pasada década. La mayoría de los melanomas se encuentran en estadio I en el momento del diagnóstico (45%). Sin embargo, se sigue diagnosticando una importante proporción de melanomas en estadios avanzados (III-IV; 14.5%). Los siguientes factores se asocian de forma significativa con una supervivencia global inferior: edad avanzada, sexo masculino, estadio clínico avanzado, tipo nodular, espesor superior a 4 mm (o nivel de Clark V), presencia de ulceración y positividad en la biopsia del ganglio centinela.

Angiokeratoma of the glans penis: clinical, histopathological and dermoscopic correlation.

Angiokeratoma is a benign vascular lesion characterized by vascular ectasia in the upper dermis and hyperkeratosis. We report a case with lesions on the glans penis, a very rare location. In addition, we report the dermoscopic findings.

[Diagnostic methods in autoimmune subepidermal bullous diseases]. / Métodos diagnósticos en las enfermedades ampollosas subepidérmicas autoinmunes.

There is considerable clinical and histological overlap among the subepidermal autoimmune bullous diseases. The knowledge at the molecular level of the dermo-epidermal junction is essential to understand this group of diseases. The immune-based techniques have contributed to increase the knowledge of these entities and have been progressively incorporated into clinical practice. In this review of the diagnostic methods of subepidermal autoimmune bullous diseases we summarize the most recent advances on the molecular biology of the dermo-epidermal junction, focusing on the immune-based diagnostic techniques. We distinguish two main groups of diagnostic methods: those that detect autoimmune deposits in the skin (direct immunofluorescence and its variants including confocal microscopy) and those that detect antibodies in serum or in other fluids (indirect immunofluorescence and its variants, ELISA, immunoblot and immunoprecipitation). We explain the methodology and diagnostic keys of the techniques most widely applied in our milieu.

Metastatic Crohn's disease mimicking genital pyoderma gangrenosum in an HIV patient.

The differential diagnosis of ulcerative genital lesions in patients with high risk sexual habits can be a challenge even for dermatologists. We present the case of a 27-year-old HIV-positive male with a history of recalcitrant genital ulcers. Microbiology studies were negative. A skin biopsy and a sample from a perineal fistula showed granulomatous infiltrates. The patient was treated with prednisone, metronidazole and aminosalicylates, showing complete resolution of the lesions in a few weeks. The clinical picture and histological findings are consistent with the diagnosis of cutaneous metastatic Crohn's disease. Although infrequent, metastatic Crohn's disease should be suspected in cases of recalcitrant ulcerative conditions, even in the absence of intestinal disease.

Pigmented axillary nodule: carcinoma of an ectopic axillary breast.

BACKGROUND: Ectopic mammary tissue appears in humans owing to an incomplete embryologic regression of the mammary ridges. The same pathology that affects normally positioned breasts, including carcinoma, can occur in ectopic mammary tissue. OBJECTIVE: The objective was to present the case of a 43-year-old woman who developed a ductal mammary carcinoma of ectopic breast tissue. METHODS: We describe the patient's history, the histologic diagnosis, and the therapy carried out. We also discuss the clinical differential diagnosis and current management options. RESULTS: The patient developed a ductal mammary carcinoma in the axilla, which is the most common site for the occurrence of carcinoma of ectopic breast tissue. She has been sucessfully treated with surgery, lymphadenectomy, radiotherapy, and chemotherapy. Accessory mammary tissue is a relatively frequent incidental finding, whereas carcinoma of ectopic tissue is very rare. CONCLUSIONS: Carcinoma occurring in ectopic breast tissue remains rare, but this diagnosis must be suspected when confronted with any axillary nodule. The prognosis is similar to carcinoma of normal breast in the same tumor, node, metastasis stage, although it has a higher rate of lymph node involvement. There is no consensus on the advisability of excising ectopic mammary tissue.