RESUMO
BACKGROUND: The prognostic benefit of health care service provision and delivery policies for patients with malignant melanoma (MM) is not yet clear. OBJECTIVE: To analyze the role of health care provision determinants in the initial prognosis of MM. METHODS: A multicenter cross-sectional study was conducted at 14 public hospitals and recruited 3550 patients with MM between 2000 and 2009. The study variables were analyzed using univariate and multivariate models to identify their role in the variations observed. RESULTS: In a 10-year period, the number of patients with MM increased by 78.54%, with primary in situ MM (Tis) or MMs with a Breslow thickness <1 mm (T1) representing 51.72% of the total number of MMs in 2000, increasing to 62.23% by the end of the study period (P = .005). Among the variables that explained the variation in MM frequency the year of diagnosis after 2004 (univariate odds ratio [OR], 1.43 [P < .001]; multivariate OR, 1.36 [P = .005]) and diagnosis in centers with specific fast-track referral systems (univariate OR, 1.24 [P = .01]; multivariate OR, 1.59 [P = .025]) were shown to explain the increasing frequency of Tis-T1 MM. LIMITATIONS: The primary potential limitation of this study is its retrospective nature. CONCLUSION: Health care provision policies and interventions aimed at improving accessibility to specialized care appear to explain the increasing frequency of Tis-T1 MM.
Assuntos
Acessibilidade aos Serviços de Saúde , Melanoma/epidemiologia , Neoplasias Cutâneas/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma in Situ/epidemiologia , Carcinoma in Situ/patologia , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Masculino , Melanoma/patologia , Pessoa de Meia-Idade , Prevenção Primária , Prognóstico , Estudos Retrospectivos , Neoplasias Cutâneas/patologia , Espanha/epidemiologia , Adulto JovemAssuntos
Dermoscopia , Pitiríase Rubra Pilar/patologia , Biópsia , Criança , Epiderme/patologia , Feminino , Humanos , Hiperplasia , Linfócitos/ultraestruturaRESUMO
We report the first case of lupus-like lesions in an infant with chronic granulomatous disease during the treatment with voriconazole for chronic invasive aspergillosis. The lesions disappeared with termination of the treatment.
Assuntos
Antifúngicos/efeitos adversos , Aspergilose/tratamento farmacológico , Doença Granulomatosa Crônica/complicações , Lúpus Eritematoso Discoide/induzido quimicamente , Pirimidinas/efeitos adversos , Triazóis/efeitos adversos , Aspergilose/complicações , Biópsia , Humanos , Lactente , Lúpus Eritematoso Discoide/patologia , Masculino , VoriconazolAssuntos
Imunoglobulinas Intravenosas/uso terapêutico , Síndrome de Linfonodos Mucocutâneos/complicações , Dermatopatias/etiologia , Amputação Cirúrgica , Proteína C-Reativa/análise , Dedos/patologia , Gangrena , Humanos , Fatores Imunológicos/uso terapêutico , Lactente , Masculino , Síndrome de Linfonodos Mucocutâneos/sangue , Síndrome de Linfonodos Mucocutâneos/patologia , Síndrome de Linfonodos Mucocutâneos/terapia , Necrose , Dermatopatias/patologiaAssuntos
Bochecha/patologia , Orelha Externa/patologia , Hanseníase Multibacilar/diagnóstico , Mycobacterium leprae/isolamento & purificação , Pele/patologia , Biópsia , Brasil , Bochecha/microbiologia , Orelha Externa/microbiologia , Feminino , Granuloma/microbiologia , Granuloma/patologia , Humanos , Hansenostáticos/uso terapêutico , Hanseníase Multibacilar/tratamento farmacológico , Hanseníase Multibacilar/microbiologia , Hanseníase Multibacilar/patologia , Pessoa de Meia-Idade , Pele/microbiologia , EspanhaAssuntos
Inflamação/diagnóstico , Micose Fungoide/diagnóstico , Neoplasias Cutâneas/diagnóstico , Vitiligo/diagnóstico , Linfócitos T CD4-Positivos/imunologia , Linfócitos T CD4-Positivos/metabolismo , Linfócitos T CD8-Positivos/imunologia , Linfócitos T CD8-Positivos/metabolismo , Diagnóstico Diferencial , Humanos , Lactente , Inflamação/imunologia , Inflamação/metabolismo , Masculino , Micose Fungoide/imunologia , Micose Fungoide/metabolismo , Neoplasias Cutâneas/imunologia , Neoplasias Cutâneas/metabolismo , Vitiligo/imunologia , Vitiligo/metabolismoAssuntos
Neoplasias Faciais/patologia , Neoplasias Cutâneas/patologia , Neoplasias das Glândulas Sudoríparas/patologia , Queixo , Diagnóstico Diferencial , Neoplasias Faciais/cirurgia , Feminino , Humanos , Imuno-Histoquímica , Pessoa de Meia-Idade , Neoplasias Cutâneas/cirurgia , Neoplasias das Glândulas Sudoríparas/cirurgiaAssuntos
Alternaria/isolamento & purificação , Dermatomicoses/diagnóstico , Alternaria/ultraestrutura , Dermatomicoses/microbiologia , Dermatomicoses/patologia , Derme/microbiologia , Derme/patologia , Humanos , Hiperplasia , Infecções Oportunistas/diagnóstico , Infecções Oportunistas/microbiologia , Infecções Oportunistas/patologiaRESUMO
BACKGROUND: Poor prognostic factors in Merkel cell carcinoma include male sex, advanced stage at diagnosis, large tumor size (>5 mm), diffuse growth pattern, heavy lymphocytic infiltrate, and high mitotic rate. To date only six cases of Merkel cell carcinoma with sarcomatous or pseudosarcomatous differentiation and poor prognosis have been documented. METHODS: We present a new case of Merkel cell carcinoma with sarcomatous differentiation. RESULTS: The immunohistochemical staining patterns reflected the morphologic differentiation of the epithelial and sarcomatous pattern. After two months of follow-up, there were no signs of local recurrence or metastases. CONCLUSION: In all cases of merkelomas with sarcomatous differentiation described to date, lymph node metastases have been found, except in the presented case. However, larger series of cases will be required to determine if sarcomatous differentiation represents another negative prognostic factor.
Assuntos
Carcinoma de Célula de Merkel/patologia , Neoplasias Cutâneas/patologia , Idoso de 80 Anos ou mais , Humanos , Masculino , PrognósticoRESUMO
BACKGROUND: Dermatomyofibroma is a rare but distinct benign cutaneous mesenchymal neoplasm of fibroblastic/myofibroblastic differentiation. It is more common in adolescents and young adults, with a female preponderance. In most cases, the lesions are asymptomatic and small, measuring from 10 to 20 mm. Early and active lesions tend to be actin positive. CASE REPORT: We present a) a new case of dermatomyofibroma in an 11-month-old male infant, the youngest case reported to date, and b) the second reported case of a giant annular dermatomyofibroma, measuring 10 cm × 6 cm, in a 52-year-old woman. In both cases, histological examination showed a spindle-cell proliferation embedded among the collagen fibers of the dermis, arranged predominantly parallel to the skin surface. In both cases the spindle cells stained positive for smooth muscle actin and the elastic fibers were increased and fragmented. CONCLUSION: Dermatologists and pediatricians should be aware of this benign entity in order to avoid unnecessary treatment.