The role of accessibility policies and other determinants of health care provision in the initial prognosis of malignant melanoma: a cross-sectional study.

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.

A rare case of primary cutaneous plasmacytoma-like lymphoproliferative disorder following renal transplantation.

Post-transplant lymphoproliferative disorder (PTLD) is a lymphoid proliferation that develops as a complication of solid organ or bone marrow transplants. PTLD limited to the skin is very rare. Plasmacytoma-like PTLD is an uncommon variant of monomorphic PTLD. Its presentation in the skin is extraordinary with very few cases reported in the literature. We report a new case of plasmacytoma-like PTLD presenting as multiple skin nodules on the leg of a 74-year-old kidney transplant recipient. Histopathologic and immunohistochemical examination of one nodule revealed atypical plasmacytoid and plasmablastic cells that showed kappa light chain restriction and stained positive for CD138. Staging investigations excluded extracutaneous manifestations of the disease. This case is unusual for several reasons including involvement limited to the skin, plasmacytoid phenotype of the tumor, presentation 18 years following transplantation and Epstein-Barr virus negativity.

Olanzapine-induced eccrine squamous syringometaplasia.

Eccrine squamous syringometaplasia is a histopathologic pattern that has mainly been described in patients receiving chemotherapy. Its association to nonchemotherapeutic agents is rare, with very few cases reported in the literature. We present the case of a 55-year-old patient with schizophrenia, who developed a skin eruption 5 weeks after initiating treatment with olanzapine. The histopathologic study revealed squamous syringometaplasia of the dermal eccrine ducts.

Clinical and pathological features of Merkel cell carcinoma: A 4-year follow-up observational retrospective study in Spain.

BACKGROUND: Merkel cell carcinoma (MCC) is a malignant skin cancer with a 5-year survival rate of approximately 50%. Knowledge of MCC has increased in recent years mostly due to improved diagnosis techniques. In Spain there is lack of information regarding the incidence and tumour characteristics, and the treatment approaches are not standardised. The objective of this study was to provide information of the clinical and epidemiological characteristics of MCC patients in Spain. METHODS: Retrospective, observational study involving 192 patients from 25 Spanish hospitals. Evaluated variables included overall survival and incidence rate of Merkel cell polyomavirus, in patients diagnosed from 2012 to 2016. RESULTS: The Spanish incidence rate was estimated 0.32/100,000 inhabitants/year, with variations according to geographical regions, being slightly higher in areas with greater sunlight exposure. In total, 61.5% of tumours showed expansive growth (progressive growth of the tumour), 78.6% showed localisation in UV-exposed skin. 97.4% of patients were diagnosed by excisional biopsy. Surgery was the first line treatment in 96.6% of patients, radiotherapy in 24.6%, and chemotherapy in 6.3%. These treatments were not mutually exclusive. Median overall survival was 38.3 months (78.4% at 12 months and 60% at 24 months). MCPyV was present in 33.8% of patients. CONCLUSION: The incidence of MCC in Spain is one of the highest in Europe, with a slight predominance in men. The sample has shown that a biopsy is available for diagnosis in most cases. Moreover, the treatment is surgical when the tumour is localized and is associated with lymphadenectomy, and/or it is radiotherapy if widespread.

Gender disparities in mortality: challenges for health equity in Puerto Rico / Disparidades de género en mortalidad: retos para la equidad en salud en Puerto Rico / Disparidades de gênero em mortalidade: desafios para a equidade na saúde em Porto Rico

The aim of this study is to deepen the analysis of mortality indicators by sex in Puerto Rico. The gender perspective is used to identify the differentials and inequalities that generate disparities in mortality among women and men in that country. In 2008-2010, life expectancy at birth for both sexes reached 78.83 years, with a gap of 7.71 years among women and men, which is higher in the group of very low mortality countries, internationally. The years of potential life lost (YPLL) by age and external causes of death and natural death are used, among other indicators, for further analysis of male mortality from a gender perspective. Young men have a very high premature mortality because many deaths are due to by external causes: homicides, suicides and accidents. In the case of women's, premature deaths are prevalent due natural causes in all age groups. The result of the study is to promote gender mainstreaming to achieve health equity for women and men. Puerto Rico requires health plans, programs and policies that take into account gender disparities in order to achieve a longer life span-free of preventable disease, disability, injury and premature death- which currently affects more men than women.

El objetivo de este estudio es profundizar en el análisis de indicadores de mortalidad por sexos en Puerto Rico, desde la perspectiva de género, con el propósito de conocer diferenciales y desigualdades que generan disparidades en la mortalidad de mujeres y hombres en ese país. En 2008-2010 la esperanza de vida al nacer de ambos sexos alcanzó 78.83 años, con una brecha de 7.71 años entre mujeres y hombres, la más elevadas en el conjunto de países de mortalidad muy baja, a escala internacional. Se utilizan los años potenciales de vida perdidos (APVP) por edades y causas de muerte externas y naturales, entre otros indicadores de mortalidad, para profundizar en el análisis de la sobre mortalidad masculina, desde una perspectiva de género. La mortalidad prematura reporta pérdidas elevadas de años de vida, en hombres jóvenes, por causas de muerte externas -homicidios, suicidios y accidentes; en el caso de las mujeres, prevalecen las causas de muerte natural en la mortalidad prematura de todas las edades. Los resultados del estudio promueven la incorporación de la perspectiva de género para lograr la equidad en salud de mujeres y hombres. En Puerto Rico se requieren planes, programas y políticas de salud, que tomen en cuenta las disparidades de género para lograr una vida más larga, libre de enfermedades evitables, invalidez, lesiones y muerte prematura, que en la actualidad afectan más a los hombres que a las mujeres.

O objetivo deste estudo é aprofundar na análise de indicadores de mortalidade por sexos em Porto Rico, desde a perspectiva de gênero, com o propósito de conhecer diferenciais e desigualdades que geram disparidades na mortalidade de mulheres e homens nesse país. Em 2008-2010 a expectativa de vida ao nascer de ambos os sexos alcançou 78,83 anos, com uma diferença de 7,71 anos entre mulheres e homens, a mais elevadas no conjunto de países de mortalidade muito baixa, na escala internacional. Utilizam-se os anos potenciais de vida perdidos (APVP) por idades e causas de morte externas e naturais, entre outros indicadores de mortalidade, para aprofundar na análise da mortalidade masculina, desde uma perspectiva de gênero. A mortalidade prematura reporta perdas elevadas de anos de vida, em homens jovens, por causas de morte externas - homicídios, suicídios e acidentes; no caso das mulheres, prevalecem as causas de morte natural na mortalidade prematura de todas as idades. Os resultados do estudo promovem a incorporação da perspectiva de gênero para obter a equidade em saúde de mulheres e homens. Em Porto Rico requerem-se planos, programas e políticas de saúde, que levem em consideração as disparidades de gênero para conseguir uma vida mais longa, livre de doenças evitáveis, invalidez, lesões e morte prematura, que na atualidade afetam mais aos homens que às mulheres.