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.

Skin Flaps for the Repair of Multiple Adjacent Tumors.

In daily clinical practice, the dermatologic surgeon frequently has to excise closely adjacent tumors in the facial region. In such cases, planning of an appropriate reconstruction technique is essential. The aim is to treat all of the lesions in a single surgical intervention, if possible, and to achieve a good functional and cosmetic outcome. We present 5 patients in whom a single flap was used to repair multiple adjacent defects.

Subcutaneous pedicled V-Y advancement flap for surgical reconstruction of the auricle of the ear.

The subcutaneous pedicled V-Y advancement flap is useful for the repair of small and medium-sized defects in areas where it is easy to obtain a good subcutaneous pedicle (upper lip, cheek, eyebrow, and nasal tip and ala). The almost complete absence of subcutaneous tissue on the anterior aspect of the auricle of the ear can limit the use of this approach in this region. We present 4 patients in whom subcutaneous pedicled V-Y advancement flaps were used to repair surgical defects of the helix, scaphoid fossa, and antitragus, achieving a good functional and aesthetic result in all cases.

Reconstructive surgery of the medial zygomatic region of the cheek: presentation of 5 cases.

The cheek is the largest anatomical subunit of the face. It is a bilateral structure and symmetry must therefore be preserved. Peripherally it is related to important natural orifices whose location must also be maintained during surgical reconstructions. This is particularly important in the medial zygomatic subunit, whose delicate junction with the lower eyelid means that care must be taken to avoid ectropion. We present 5 options for the reconstruction of surgical defects secondary to the excision of tumors in this region.

Surgical principles for achieving a functional and cosmetically acceptable scar.

Dermatologic surgery can sometimes result in scars that are less than satisfactory. Such results, and hence the need for scar revision, can be avoided with careful planning and the use of appropriate surgical techniques. In this practical review, we describe several techniques that will improve functional and cosmetic outcomes. While Z-plasty and its variants are simple yet essential surgical procedures, they can represent a challenge for less experienced surgeons. By gaining a clear understanding of the principles of Z-plasty, the dermatologic surgeon will be able to employ this technique, either alone or with other surgical techniques, in a range of clinical situations.

[Etanercept and infection - latent tuberculosis]. / Etanercept e infección latente tuberculosa.

Drugs that block the tumor necrosis factor alpha (TNFalpha) increase the risk of reactivation of latent tuberculosis infection (LTI). The risk is greater with monoclonal antibodies than with etanercept. In order to reduce this risk, screening of latent tuberculosis infection should be performed prior to the initiation of the treatment. Screening includes a complete clinical history, physical examination, tuberculin test, in vitro detection of interferon-gamma (INF-gamma) production and a chest x-ray. The limitations of the different tests should be taken into consideration by the physician. After the diagnosis of latent tuberculosis infection, the patient must receive treatment with isoniacide for 9 months. In spite of screening and adequate treatment of latent tuberculosis treatment, the patients receiving treatment with anti-TNFalpha drugs may develop active tuberculosis. Thus, the patient should undergo clinical follow-up to detect signs of active tuberculosis with atypical and disseminated pictures.

[Quinacrine in the treatment of cutaneous lupus erythematosus: practical aspects and a case series]. / Aspectos prácticos de la quinacrina como tratamiento del lupus eritematoso cutáneo: serie de casos.

Hydroxychloroquine and chloroquine are antimalarials used as first-line treatment of cutaneous lupus. Quinacrine is not often employed by Spanish physicians due to a lack of information about its use and the fact that it is not marketed in Spain. It is effective in monotherapy or in combination therapy with other antimalarials. One of the advantages of quinacrine over chloroquine and hydroxychloroquine is that it does not appear to cause retinal toxicity. Quinacrine is used as second-line therapy in patients with pre-existing eye problems that contraindicate treatment with chloroquine or hydroxychloroquine (after evaluation of which drug has the better risk-benefit relationship), and in combination therapy with other antimalarials inpatients with resistance or only a partial response to chloroquine or hydroxychloroquine. We report 8 cases of patients with cutaneous lupus who received treatment with quinacrine in monotherapy or in combination with others antimalarials. Lesions resolved in 5 patients and improved in 3. Therapy had to be withdrawn in 1 patient due to an exacerbation of his psoriasis.