Squamous Cell Carcinoma: Clinical and Pathological Features and Associated Risk Factors in an Observational Study of 118 Patients.

BACKGROUND AND OBJECTIVE: In the latest edition of its cancer staging manual, the American Joint Committee on Cancer (AJCC) revised the criteria for staging squamous cell carcinoma (SCC) by introducing high-risk tumor features to define tumor stage (T) and help to identify tumors with a higher risk of metastasis. The aim of this study was to investigate the characteristics associated with SCC meeting the high-risk criteria defined by the AJCC for T2 lesions. PATIENTS AND METHOD: We performed a case-case observational study in which patients with SCC were included over a period of 18 months. We collected clinical, anthropometric, and tumor data, and analyzed these using PASW Statistics (SPSS) version 18. RESULTS: One-hundred eighteen patients, the majority of whom were men, were included. Mean age was 77 years. Over 70% of the tumors were located in the head region and a majority of tumors measured 2 cm or less. The prevalence of SCC T2 was 61.9%. The risk factors significantly associated with SCC T2 were an age of over 85 years (odds ratio [OR], 4.48), location in the head and neck region (OR, 3.38), presence of solar elastosis in the peritumoral tissue (OR, 2.08), a higher tumor growth rate (>1.5 mm·wk(-1); OR, 5.73), and higher cumulative exposure to smoking (>20 pack-years, OR, 3.63). CONCLUSIONS: Advanced age, location in the head and neck region, presence of solar elastosis, high tumor growth rate, and high cumulative smoking exposure were all significantly associated with the presence of SCC T2.

Vitamin D and cutaneous lupus erythematosus: effect of vitamin D replacement on disease severity.

BACKGROUND: The main vitamin D source is exposure to ultraviolet radiation, which aggravates cutaneous lupus erythematosus (CLE). OBJECTIVES: The aims of this study were to identify variables associated with lower serum 25-hydroxyvitamin D [25(OH)D] levels in CLE patients and assess the effect of vitamin D restoration on disease severity. METHODS: Vitamin D status in 60 CLE patients and 117 apparently healthy subjects was compared. We recommended oral vitamin D3 to 27 CLE patients. After one year of treatment, changes in disease severity were assessed and compared to 25 untreated CLE patients. Disease severity was measured by the Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI), number of exacerbations, duration of active lesions and patient assessment. RESULTS: Presence of CLE raised the odds of having vitamin D deficiency (OR 3.47, 95% CI 1.79-6.69). Increasing age and disease duration were associated with higher odds of having vitamin D deficiency. After a one-year follow-up, disease activity improved in the treatment group (CLASI A 2.7 ± 2.9 vs. 0.9 ± 1.4) (p = 0.003), as confirmed by the patient assessment (p = 0.01). CONCLUSIONS: Vitamin D inadequacy is more prevalent in CLE participants than in healthy controls. Treating vitamin D insufficiency is associated with improved disease severity according to physician and patient assessments.

Detection of human papillomavirus in nonmelanoma skin cancer lesions and healthy perilesional skin in kidney transplant recipients and immunocompetent patients.

BACKGROUND: The influence of human papillomavirus (HPV) on the development of nonmelanoma skin cancer (NMSC) is a topic of debate. HPV types from the beta genus (HPV-ß) have been most frequently associated with the development of skin cancer. OBJECTIVES: To analyze the prevalence and range of HPV types in NMSC lesions and healthy perilesional skin in immunodepressed and immunocompetent patients and to evaluate the influence of various clinical factors on the prevalence of HPV in skin cancer. METHODS: Nested polymerase chain reaction and sequencing were used to detect HPV in 120 NMSC samples obtained by biopsy from 30 kidney transplant recipients and 30 immunocompetent patients. In all cases, a sample was taken from the tumor site and the surrounding healthy skin. Potential confounders were assessed and the data analyzed by multivariate logistic regression. RESULTS: HPV DNA was detected in 44 (73.3%) of the 60 samples from immunodepressed patients and in 32 (53.3%) of the 60 samples from immunocompetent patients (adjusted odds ratio, 3.4; 95% CI, 1.2-9.6). In both groups of patients, HPV was more common in healthy perilesional skin than in lesional skin. HPV-ß was the most common type isolated. CONCLUSION: We found a wide range of HPV types (mostly HPV-ß) in the skin of kidney transplant recipients and immunocompetent patients with skin cancer.

The role of new immunosuppressive drugs in nonmelanoma skin cancer in renal transplant recipients.

INTRODUCTION: Nonmelanoma skin cancer (NMSC) is the most common malignancy in patients who have received a solid organ transplant. Multiple factors are involved in the onset of posttransplant NMSC. OBJECTIVES: To analyze the relationship between new immunosuppressive drugs and the onset of NMSC in renal transplant recipients. METHOD: This was a combined retrospective and prospective observational study in which we studied 289 patients who received a kidney transplant between January 1996 and December 2010 at Hospital Universitario Doctor Peset in Valencia, Spain. RESULTS: Seventy-three patients (25.2%) developed 162 NMSCs over a median follow-up of 72 months. There were no statistically significant differences in the onset of NMSC on comparing different induction therapy strategies involving monoclonal and polyclonal antibodies. NMSCs occurred less frequently in patients treated with mammalian target of rapamycin (mTOR) inhibitors than in those treated with other immunosuppressive regimens, although the differences were not statistically significant. Three of 5 patients with recurrent NMSC who were switched from calcineurin inhibitors to mTOR inhibitors developed additional NMSCs despite the change. CONCLUSIONS: Induction therapy with monoclonal and polyclonal antibodies in renal transplant recipients is not associated with an increased risk of NMSC. While mTOR inhibitors are associated with a lower risk of posttransplant NMSC, it remains to be determined whether a switch to these drugs is useful in the management of patients who develop multiple NMSCs.

Serum 25-hydroxyvitamin D levels in patients with cutaneous lupus erythematosus in a Mediterranean region.

Low vitamin D levels have been found in patients with autoimmune diseases, including type I diabetes, rheumatoid arthritis, multiple sclerosis and systemic lupus erythematosus. The main source of vitamin D is exposure to sunlight, but the same solar radiation is known to exacerbate lupus erythematosus. We investigated the prevalence of vitamin D insufficiency in patients with cutaneous lupus erythematosus (CLE). We designed a cross-sectional study including 55 patients with CLE to measure their serum 25-hydroxyvitamin D (25(OH)D) by chemiluminescence immunoassay and compare it with a control group consisting of 37 healthy sex and age-matched subjects recruited from the patients' relatives as well as healthcare workers. Correlations with clinical and demographic variables were determined. Approximately 95% of patients with CLE had less than 30 ng/ml of serum 25(OH)D, which is accepted as the lower limit for vitamin D adequacy. Mean serum vitamin D values were significantly lower than controls (p = 0.038) and were associated with higher levels of parathyroid hormone (p = 0.050). A history of CLE was a strong predictor of insufficiency of vitamin D (odds ratio 4.2; 95% confidence interval 1.0-17.4). The results suggest a role of CLE in the metabolism of the vitamin and provide guidance for future studies looking at a potential role for vitamin D in the prevention and treatment of CLE. Lupus (2010) 19, 810-814.

[Sentinel lymph node biopsy in patients with melanoma]. / La técnica del ganglio centinela en pacientes con melanoma.

INTRODUCTION AND OBJECTIVES: The incidence of melanoma is currently increasing worldwide. One of the factors influencing disease prognosis is the presence of regional lymph node metastases. Sentinel lymph node biopsy attempts to identify subclinical lymph node metastasis as a prognostic factor in the disease. The aim of this study was to analyze differences between patients with melanoma for whom positive or negative results were obtained in sentinel lymph node biopsy and to assess the impact of the technique on disease prognosis. MATERIAL AND METHODS: Sentinel lymph node biopsy was carried out in patients with melanoma of the following characteristics: Breslow thickness > or =1mm, Breslow thickness <1mm with ulceration, Clark level IV-V, or regression. Lymphadenectomy was performed in patients with positive sentinel node biopsy. Data were also collected on the following variables: sex, age, skin phototype, site and type of melanoma, Breslow depth, Clark level, ulceration, regression, cancer stage at diagnosis, TNM classification, change in cancer stage during follow-up, and death due to melanoma. RESULTS: Positive sentinel node biopsies were recorded in 19.44% of patients. Positive results were associated with the following variables: nodular melanoma (crude odds ratio [ORc] compared with superficial spreading melanoma, 3.44; 95% confidence interval [CI], 1.33-8.90); Breslow thickness >2.0, for a thickness of 2.1-4.0 (ORc, 21.12; 95% CI, 2.60-172.03) and for a thickness >4.0 (ORc, 23.25; 95% CI, 2.44-221.73); Clark level IV (ORc, 8.73; 95% CI, 1.03-74.12); ulceration (ORc, 4.86; 95% CI, 1.58-14.90); T3 (ORc, 4.20; 95% CI, 1.52-11.63) and T4 (ORc, 4.67; 95% CI, 1.27-17.15) in the TNM classification; change in cancer stage during follow-up (ORc, 7.20; 95% CI, 2.25-22.99); and death due to melanoma (ORc, 8.67; 95% CI, 3.62-96.15). CONCLUSIONS: These results confirm the prognostic importance of sentinel lymph node biopsy, which facilitates identification of patients with a greater tendency towards disease progression and death due to melanoma.

Mycosis fungoides: review of epidemiological observations.

BACKGROUND: Mycosis fungoides (MF) is a chronic cutaneous T-cell lymphoma characterized by small cells with cerebriform nuclei that usually express a mature peripheral T-helper cell (CD4+) immunophenotype. Its evolution is typically quite slow, with years between the first manifestations and development of advanced stages of disease. OBJECTIVE: The purpose of the present paper is to contribute to the material about MF already present in the literature. The review articles that have appeared to date fundamentally address the morphological characteristics, diagnostic criteria and treatment of the disease; in contrast, the present study centers on the evolution of the incidence of MF and on the knowledge of the possible risk factors implicated in its development. METHODS: Review of published papers about MF epidemiology. RESULTS: The evidence suggests that the incidence is increasing, but this may be artifactual due to improved diagnostic techniques. The risk of MF is limited to gender and race, being higher in males and in blacks. Survival is highly stage dependent, but 90% of patients survive 15 years with only 10% of cutaneous involvement. Few risk factors have been identified, but several studies have found an association with industrial exposure, particularly to oils. CONCLUSION: MF is a rare disease and its risk factors have not been studied in any great detail. A European case-control study in progress will substantially increase the evidence available and progress towards identifying a prevention strategy.

[Kawasaki disease. Report of two cases]. / Enfermedad de Kawasaki. Presentación de dos casos.

We present two reports of Kawasaki's disease. The first a five months old male, which was diagnosed through autopsy developed cardiovascular complications (myocarditis, coronary aneurysms, myocardial infarction) which led to death. The second one a two years and ten months old female, which was diagnosed at the fifth day of illness, was treated with aspirin at rate of 100 mg/kg/day and healed without consequences. It is interesting to emphasize the different development as a function of age, sex and precocity of diagnosis.

[Contact allergic dermatitis in childhood: 1972-1987]. / Dermatitis alérgica de contacto en la infancia: 1972-1987.

We have carried out retrospective study of 190 children with dermatitis, aged from 2 to 14 years old. 67 (35%) of these children showed positive patch-test reactions. Nickel sulphate (35%) was the first allergen. Form 1979, once mercury was introduced in the GEIDC standard series, it becomes the more common iatrogenic allergen in childhood in our country. Other allergens also responsible for the dermatitis were mercaptobenzothiazole (12%), cobalt (9%) and p-phenylenediamine (7%).