Risk of a Second Skin Cancer in a Cohort of Patients With Nonmelanoma Skin Cancer -Basal Cell Carcinoma or Squamous Cell Carcinoma-Treated With Mohs Micrographic Surgery: A National Prospective Cohort Study. / Riesgo de aparición de segundas neoplasias cutáneas en una cohorte de pacientes diagnosticados de carcinoma queratinocítico (carcinoma basocelular y carcinoma epidermoide) tratados con cirugía de Mohs. Estudio de cohortes prospectivo nacional.

OBJECTIVE: Patients with nonmelanoma skin cancer (NMSC)-ie, basal cell carcinoma (BCC) or squamous cell carcinoma (SCC)-have an increased risk of developing a second skin cancer. The aim of this study was to describe the frequency, incidence per 1000 person-years, and predictors of a second skin cancer in a cohort of patients with NMSC treated with Mohs micrographic surgery (MMS). MATERIAL AND METHODS: Prospective study of a national cohort of patients with NMSC who underwent MMS at 22 Spanish hospitals between July 2013 and February 2020; case data were recorded in the REGESMOHS registry. The study variables included demographic characteristics, frequency and incidence per 1000 person-years of second skin cancers diagnosed during the study period, and risk factors identified using mixed-effects logistic regression. RESULTS: We analyzed data for 4768 patients who underwent MMS; 4397 (92%) had BCC and 371 (8%) had SCC. Mean follow-up was 2.4 years. Overall, 1201 patients (25%) developed a second skin cancer during follow-up; 1013 of the tumors were BCCs (21%), 154 were SCCs (3%), and 20 were melanomas (0.4%). The incidence was 107 per 1000 person-years (95% CI, 101-113) for any cancer, 90 per 1000 person-years (95% CI, 85-96) for BCC, 14 (95% CI, 12-16) per 1000 person-years for SCC, and 2 (95% CI, 1-3) per 1000 person-years for melanoma. More men than women developed a subsequent skin cancer (738 [61%] vs 463 [39%]). The main risk factors were a history of multiple tumors before diagnosis (relative risk [RR], 4.6; 95% CI, 2.9-7.1), immunosuppression (RR, 2.1; 95% CI, 1.4-3.1), and male sex (RR, 1.6; 95% CI, 1.4-1.9). CONCLUSION: Patients have an increased risk of developing a second tumor after MMS treatment of NMSC. Risk factors are a history of multiple tumors at diagnosis, immunosuppression, and male sex.

[Update of hidradenitis suppurativa in Primary Care]. / Actualización en hidrosadenitis supurativa en Atención Primaria.

Hidradenitis suppurativa is a prevalent disease that is noted for its clinical variability and by its severe impact on quality of life. A meticulous scientific literature review is presented in this article in order to give an update on what is known on this condition. Primary Care physicians obviously play an important role in the early diagnosis and management of hidradenitis suppurativa. This review aims to provide a current and practical overview about this disease in order to optimise the healthcare for these patients by making the best use of available resources.

The Usefulness of 0.2% Topical Nitroglycerin for Chondrodermatitis Nodularis Helicis.

BACKGROUND AND OBJECTIVE: Chondrodermatitis nodularis helicis (CNH) is a painful idiopathic degenerative condition involving the skin and cartilage of the helix or antihelix of the ear. Topical nitroglycerin 2% is a relatively recent treatment option for CNH that has produced good results, although with adverse effects (17% of cases). The use of a lower concentration would probably achieve similar results with fewer adverse effects. The aim of this study was to evaluate the effectiveness and safety of topical nitroglycerin 0.2% in the treatment of CNH. MATERIAL AND METHODS: We performed a retrospective observational study of patients treated in 2 Spanish hospitals between 2012 and 2014. The effectiveness of treatment was determined by clinical photography and assessment of symptoms using a verbal numerical rating scale. RESULTS: Of the 29 patients treated, 93% showed clinical improvement. In the group of responders, mean treatment duration was 1.8 months and mean follow-up was 5.9 months. Overall tolerance was good in all cases. CONCLUSION: Topical nitroglycerin 0.2% is an effective and well-tolerated conservative treatment option that improves the appearance of lesions and provides symptomatic relief in the majority of patients with CNH.

Cutaneous squamous cell carcinoma: defining the high-risk variant.

With a lifetime incidence of approximately 10% in the general population, cutaneous squamous cell carcinoma (CSCC) is the second most common type of nonmelanoma skin cancer. Most CSCCs are benign and can be completely eradicated by surgery or other dermatological procedures. There is, however, a subgroup associated with an increased likelihood of lymph node metastases and, therefore, with high morbidity and mortality. This article analyzes the various factors that define aggressive CSCC. We propose a method for defining high-risk SCC on the basis of a series of major and minor criteria. This method will allow better prognostic evaluation and enable personalized management of patients with high-risk SCC, possibly leading to improved overall survival.

Biosynthetic porcine collagen dressings as an adjunct or definitive tool for the closure of scalp defects without periosteum.

BACKGROUND: Aggressive carcinomas of the scalp usually occur in elderly patients with multiple comorbidities. Complete excision of this type of tumor often involves the removal of periosteum, and the resulting defects can be difficult to reconstruct. OBJECTIVE: To evaluate the usefulness of porcine type I collagen dressings as adjunct or definitive treatment in the surgical closure of scalp defects without periosteum. MATERIALS AND METHODS: We performed a prospective study between January 2009 and November 2011 of patients with scalp defects larger than 5cm resulting from surgery that required the removal of periosteum to obtain tumor-free margins. RESULTS: The most prevalent type of tumor was recurrent cutaneous squamous cell carcinoma. The surgical defects ranged in diameter from 5 to 7cm. In 100% of the patients who received a graft after dressing removal (n=4), the graft took well. In the patients in whom the biosynthetic dressing was definitive (n=6), granulation tissue filled the defect and complete closure was achieved in approximately 3.5 months. CONCLUSIONS: The use of porcine type I collagen dressings as an adjunct or definitive tool for the closure of surgical defects on the scalp measuring more than 5cm in which periosteum has been removed proved to be simple, inexpensive, and effective.

Biosynthetic Porcine Collagen Dressings as an Adjunct or Definitive Tool for the Closure of Scalp Defects Without Periosteum. / Parche biosintético de colágeno porcino como herramienta coadyuvante o definitiva en el cierre de defectos del cuero cabelludo sin periostio.

BACKGROUND: Aggressive carcinomas of the scalp usually occur in elderly patients with multiple comorbidities. Complete excision of this type of tumor often involves the removal of periosteum, and the resulting defects can be difficult to reconstruct. OBJECTIVE: To evaluate the usefulness of porcine type I collagen dressings as adjunct or definitive treatment in the surgical closure of scalp defects without periosteum. MATERIALS AND METHODS: We performed a prospective study between January 2009 and November 2011 of patients with scalp defects larger than 5cm resulting from surgery that required the removal of periosteum to obtain tumor-free margins. RESULTS: The most prevalent type of tumor was recurrent cutaneous squamous cell carcinoma. The surgical defects ranged in diameter from 5 to 7cm. In 100% of the patients who received a graft after dressing removal (n=4), the graft took well. In the patients in whom the biosynthetic dressing was definitive (n=6), granulation tissue filled the defect and complete closure was achieved in approximately 3.5 months. CONCLUSIONS: The use of porcine type I collagen dressings as an adjunct or definitive tool for the closure of surgical defects on the scalp measuring more than 5cm in which periosteum has been removed proved to be simple, inexpensive, and effective.

[Intralesional infusion of methotrexate as neoadjuvant therapy improves the cosmetic and functional results of surgery to treat keratoacanthoma: results of a randomized trial]. / Ensayo clínico: la infiltración intralesional con metotrexato de forma neoadyuvante en la cirugía del queratoacantoma permite obtener mejores resultados estéticos y funcionales.

BACKGROUND: Keratoacanthoma is currently considered to be an in situ squamous cell carcinoma that mainly affects patients over 70 years of age. The tumor has a good prognosis and, in some cases, can resolve spontaneously. Treatment involves simple excision. However, since the tumors generally occur on the face or extremities and display rapid growth, aggressive surgery may be required and the cosmetic results may be poor. OBJECTIVE: The primary study objective was assessment of the efficacy of presurgical intralesional methotrexate infiltration to reduce the size of the tumor and the corresponding surgical defect. MATERIAL AND METHODS: A prospective, randomized study was undertaken in patients with a diagnosis of keratoacanthoma of at least 1.5 cm who were seen in our service between January 2009 and January 2010. Two groups were established: one receiving a single infiltration of methotrexate prior to surgery and another that did not receive methotrexate. RESULTS: Of the 25 patients included in the study, 10 received neoadjuvant intralesional methotrexate (group A) and 15 underwent surgery without prior infiltration of methotrexate (group B). The patients in group A displayed a reduction of between 50% and 80% in the size of the lesion prior to surgery. No complications were observed either in relation to methotrexate infusion or surgery. In group B, only 1 patient had a slight reduction in the dimensions of the lesion prior to surgery. In the remaining cases, the lesions remained similar (4 cases, 26%) or had increased in size (10 cases, 66%) at the time of surgery. Five patients in this group required hospital admission following surgery. CONCLUSIONS: Neoadjuvant intralesional methotrexate is well tolerated and reduces the need for aggressive surgery in elderly patients with keratoacanthoma measuring more than 1.5 cm on the face or extremities.

[Store-and-forward teledermatology: assessment of validity in a series of 2000 observations]. / Teledermatología diferida: análisis de validez en una serie de 2.000 observaciones.

BACKGROUND AND OBJECTIVES: The aim of this study was to assess the validity of store-and-forward teledermatology as a tool to support physicians in primary care and hospital emergency services and reduce the requirement for face-to-face appointments. Diagnostic validity and the approach chosen for patient management (face-to-face vs teledermatology) were compared according to patient origin and diagnostic group. MATERIAL AND METHODS: Digital images from 100 patients were assessed by 20 different dermatologists and the diagnoses offered were compared with those provided in face-to-face appointments (gold standard). The proposed management of the different groups of patients was also compared. RESULTS: The percentage complete agreement was 69.05% (95% confidence interval [CI], 66.9%-71.0%). The aggregate agreement was 87.80% (95% CI, 86.1%-89.0%). When questioned about appropriate management of the patients, observers elected face-to-face consultation in 60% of patients (95% CI, 58%-61%) and teledermatology in 40% (95% CI, 38%-41%). Diagnostic validity was higher in patients from primary care (76.1% complete agreement and 91.8% aggregate agreement) than those from hospital emergency services (61.8% complete agreement, 83.4% aggregate agreement) (p < 0.001) and teledermatology was also chosen more often in patients from primary care compared with those from emergency services (42% vs 38%; p=0.003). In terms of diagnostic group, higher validity was observed for patients with infectious diseases (73.3% complete agreement and 91.3% aggregate agreement) compared to those with inflammatory disease (70.8% complete agreement and 86.4% aggregate agreement) or tumors (63.0% complete agreement and 87.2% aggregate agreement) (p <0.001). Teledermatology was also chosen more often in patients with infectious diseases (52%) than in those with inflammatory disease (40%) or tumors (28%) (p <0.001). CONCLUSIONS: Store-and-forward teledermatology has a high level of diagnostic validity, particularly in those cases referred from primary care and in infectious diseases. It can be considered useful for the diagnosis and management of patients at a distance and would reduce the requirement for face-to-face consultation by 40%.

[Metastatic Basal cell carcinoma in the axilla: reconstruction with a lateral pectoral island flap]. / Carcinoma basocelular metastásico en la axila: reconstrucción mediante un colgajo en isla pectoral lateral.

Although basal cell carcinoma (BCC) is one of the most common forms of cancer worldwide, it rarely occurs in the axilla. Only 31 cases have been reported in the literature. The incidence of metastatic BCC, particularly in areas not exposed to the sun, is very low. We present a new case of axillary BCC with lymph node metastases and the results of an extensive review of cases previously reported in the literature. BCC in the axilla is rare and metastasis is exceptional. Factors other than UV radiation probably contribute to its development. The lateral pectoral island flap was used for surgical closure. This method is useful for the reconstruction of axillary defects, obtaining excellent cosmetic and functional results. This flap should therefore be considered for the repair of large surgical defects in the axilla.

[Acquired progressive lymphangioma (benign lymphangioendothelioma)]. / Linfangioma progresivo adquirido (linfangioendotelioma benigno).

Acquired progressive lymphangioma is a rare vascular tumor with a locally aggressive behavior. Histologically it is characterized by a proliferation of numerous, dilated, thin-walled vessels lined by flat endothelial cells with no nuclear atypia. The vessels appear to dissect between the collagen fibers. It usually presents as an asymptomatic, slow-growing, reddish-brown plaque. We present the case of a 32-year-old man with acquired progressive lymphangioma. The tumor was in the hypogastric region and had arisen on a congenital vascular lesion previously diagnosed as multifocal cutaneous angiomatosis. It was very painful and impeded walking, for which reason it was decided to perform excision. Dermatologists and pathologists must be aware of acquired progressive lymphangioma as early surgical treatment, while the lesion is still small, is curative and prevents subsequent complications due to growth.

[Lymphomatoid papulosis in children: report of 9 cases and review of the literature]. / Papulosis linfomatoide en la infancia: presentación de 9 casos y revisión de la literatura.

BACKGROUND: Lymphomatoid papulosis is a rare lymphoproliferative T cell CD30+ disease with excellent prognosis which affects almost exclusively adult patients, being rarely in the childhood; thus the clinic and pathologic spectrum and the risk of evolution to another type of lymphoma are not well defined in the pediatric group. OBJECTIVE: The aim of this article is to analyze the characteristics of infantile lymphomatoid papulosis and review the literature. MATERIAL AND METHOD: A retrospective study analyzing the characteristics of 9 patients aged up to 18 diagnosed of lymphomatoid papulosis attended in our department from 1995 to 2009 was performed. RESULTS: The study included 7 boys and 2 girls aged between 2 and 17. Pityriasis lichenoides acuta's lesions appeared associated before and after lymphomatoid papulosis' development in 2 and 1 cases respectively. The lesions resolved spontaneously, leaving a postinflammatory hyperpigmentation (77%) or hypopigmentation (23%). The development of varioliform scars occurred in over 77% of cases. Histologically, all cases showed features compatible with type A of lymphomatoid papulosis. Molecular studies showed monoclonality in the 3 cases in which this technique was done. CONCLUSIONS: Infantile lymphomatoid papulosis is a rare entity clinically manifested as the adult form. This lymphoproliferative disease, which is occasionally associated with pityriasis lichenoides acuta, shows features compatible with the type A or histiocytoid pattern in the histological analysis. The development of other lymphoproliferative disorders is less frequent in the infantile form than in the adulthood. The prevalent association among pityriasis lichenoides and lymphomatoid papulosis observed in our analysis, as well as the difficulties which supposed to differentiate between these two pathologies in various cases, suggest that those entities could be part of a common clinical and pathological spectrum.

Definition of the features of acquired elastotic hemangioma reporting the clinical and histopathological characteristics of 14 patients.

BACKGROUND: During the last few years, new cutaneous vascular proliferations have been described, including a distinctive clinicopathologic variant of hemangioma, denominated acquired elastotic hemangioma. To date, there is only one series of six cases reported in the literature, thus, the clinical and morphological data of this variant are not well established. METHODS: Fourteen cases of acquired elastotic hemangioma were retrieved from the files of the Dermatopathology Unit at Wake Forest University School of Medicine. RESULTS: Acquired elastotic hemangioma affects sun-damaged skin of upper extremities and neck. Clinically, lesions present as slowly growing, painless, solitary, erythematous plaques. Histopathologically, they are characterized by a horizontal proliferation of capillary blood vessels in the upper reticular dermis in a background of solar elastosis. The vessels have plump endothelial cells that protrude into the vascular lumens in a 'hobnail' pattern. Of the 10 cases assessed by immunohistochemistry, 100% (10) expressed CD31 and CD34, 90% (9) expressed D2-40 and 10% (1) expressed SMA. CONCLUSION: Acquired elastotic hemangioma is a distinctive variant of hemangioma which should be differentiated from other cutaneous vascular tumors with a hobnail endothelial pattern, including angiosarcoma. The expression of D2-40 in most cases suggests a lymphatic origin of this acquired vascular proliferation.

[Multiple, painful, treatment-resistant leg ulcers associated with dermatomyositis-like lesions over the interphalangeal joints induced by hydroxyurea]. / Ulceras dolorosas múltiples en la pierna resistentes al tratamiento asociadas a lesiones dermatomiositis-like en las articulaciones interfalángicas de las manos: hidroxiurea como agente causal.

The onset of a dermatomyositis-like rash and persistent skin ulcers during long-term treatment with hydroxyurea is a very rare event that has not been fully described in the literature. The fact that these lesions have a typical clinical presentation and course, and that complete resolution can only be achieved by immediate withdrawal of the drug, means that dermatologists should be aware of this condition in order to avoid a delay in diagnosis. We present the case of a 76-year-old woman who developed a dermatomyositis-like eruption associated with chronic ulcers on the lower limbs during long-term treatment with hydroxyurea.

[Oral leukoplakia: clinical, histopathologic, and molecular features and therapeutic approach]. / La leucoplasia oral: definición de parámetros clínicos, histopatológicos y moleculares y actitud terapéutica.

Dermatology departments are currently seeing an increase in the number of cases of oral diseases. Of note among the range of lesions covered by this broad area of knowledge is oral leukoplakia-the most common precancerous lesion and the most problematic in terms of both diagnosis and therapeutic management. In addition to defining leukoplakia, this review also establishes a differential diagnosis with the other most important oral diseases and analyzes the different clinical, histologic, and molecular features that can provide an indication of the risk of malignant transformation. Finally, a therapeutic algorithm is presented to help us optimize clinical management of the disease.