Multicenter case-control study of risk factors for cutaneous melanoma in Valencia, Spain.

INTRODUCTION: It is important to identify subgroups within the general population that have an elevated risk of developing cutaneous melanoma because preventive and early-detection measures are useful in this setting. The findings of most studies that have evaluated risk factors for cutaneous melanoma are of limited application in Spain because the populations studied have different pigmentary traits and are subject to different environmental factors. OBJECTIVE: To identify the phenotypic characteristics and amount of exposure to sunlight that constitute risk factors for cutaneous melanoma in the population of the Autonomous Community of Valencia, Spain. METHODS: We performed a multicenter observational case-control study. In total, the study included 242 patients with melanoma undergoing treatment in 5 hospitals and 173 controls enrolled from among the companions of the patients between January 2007 and June 2008. The information was collected by means of a standardized, validated questionnaire. The odds ratio (OR) was calculated for each variable and adjusted using a multiple logistic regression model. RESULTS: The risk factors found to be statistically significant were skin phototypes I and II, blond or red hair, light eye color, abundant melanocytic nevi, and a personal history of actinic keratosis or nonmelanoma skin cancer. After the multivariate analysis, only blond or red hair (OR=1.9), multiple melanocytic nevi (OR=3.1), skin phototypes i and ii (OR=2.1), and a personal history of actinic keratosis (OR=3.5) or nonmelanoma skin cancer (OR=8.1) maintained significance in the model as independent predictive variables for melanoma. CONCLUSIONS: Our study supports the importance of certain factors that indicate genetic predisposition (hair color and skin phototype) and environmental factors associated with exposure to sunlight. Patients with multiple acquired melanocytic nevi and patients with markers of chronic skin sun damage (actinic keratosis and nonmelanoma cancer) presented a significant increase in risk.

Tuberculous empyema necessitatis. A rare cause of cutaneous abscess in the XXI century.

A 24-year-old Moroccan man was admitted to the hospital because of a tumor of the abdominal wall, fever, and purulent sputum. Imaging tests showed the presence of a pleural effusion and tumor in the right abdominal wall. The organized collection of liquid in the mass was contiguous with the thoracic collection and that of the subphrenic space. Thoracocentesis removed purulent material suggestive of empyema. Cultures and polymerase chain reaction (PCR) tests confirmed the diagnosis of tuberculous empyema. Empyema necessitatis refers to empyema that extends into the extrapleural space through a defect in the pleural surface. Various infectious etiologies may be responsible. Tuberculous empyema necessitatis is a rare complication of tuberculosis (TB); our case is even more unusual because this condition presented as an abdominal wall abcess and the patient was immunocompetent. His only predisposing factors were his country of origin, where there is a high prevalence of TB and the delay in diagnosis due to a lack of access to health care.

[A case of Carney syndrome]. / Un caso de síndrome de Carney.

The Carney complex is an autosomal dominant syndrome characterised by multiple neoplasies, including myxomas at various sites (cardiac, cutaneous, mammary), spotty pigmentation, endocrine overactivity (Cushing's syndrome, acromegalia), testicular tumours and schwannomas. This report describes the case of a 43-year-old woman with an acute inferior myocardial infarction, probably due to coronary embolization from a large left atrial myxoma and who presented this association. A brief review of the Carney complex is provided after discussion of this rare case that required an screening of family members.

[Diffuse melanosis in metastatic malignant melanoma with melanuria]. / Melanosis difusa en melanoma maligno metastásico con melanuria.

We report an additional case of diffuse melanosis secondary to metastases from malignant melanoma in a patient, who was seen in our department shortly before death. We couldn't localize the origin of the primary neoplasm. After reporting the case, we discuss the pathogenesis of melanosis and possible sites of the primary tumor.

[Densitometry study of the Langerhans cells in human skin]. / Estudio densitométrico de las células de Langerhans en piel humana.

A densitometric study of Langerhans cells with ATPase technique is made. 62 samples of normal skin were studied. The buttocks and upper limbs showed the highest density of Langerhans cells. No differences related to age and sex were found.

[Distribution of Langerhans cells in spinocellular epitheliomas]. / Distribución de las células de Langerhans en epiteliomas espinocelulares.

The authors perform and study about Langerhans cell's distribution on squamous cell carcinomas and on one ecrine porocarcinoma. We used OKT6 and HLA-Dr antigens with fluorescein. We observed a higher density of these cells on the tumors more differentiated. On the other hand, we have seen that tumoral cells of the ecrine porocarcinoma display HLA-Dr antigens.

[Netherton syndrome]. / Síndrome de Netherton.

The authors reported a case of Netherton's syndrome. This patient presented cutaneous lesions of ichthyosis linearis circumflexa, tricorrexis invaginata and atopy signs associated with cystinuria. Cutaneous and hair lesions were treated with etretinate.

[Melkersson-Rosenthal syndrome. Oligosymptomatic form developed during medical treatment of a phobic depressive process]. / Síndrome de Melkersson-Rosenthal. Forma oligosintomática desencadenada durante el tratamiento médico de un proceso depresivo fóbico.

An oligosymptomatic form of Melkersson-Rosenthal syndrome which developed following psychiatric treatment for depressive phobic disease is presented. Morphological characteristics found in gingival mucosa biopsy are commented on, as well as the evolutive course and therapeutic procedures carried out on the patient.

[Gianotti-Crosti syndrome in an adult]. / Síndrome de Gianotti-Crosti en un adulto.

A 31 years old woman had an exanthematic eruption of small and acral distributed papules. At the same time she suffered a clinical and biological hepatitis B. This case is described attending to the clinic, histopathology and direct immunofluorescence. By the way the Gianotti-Crosti syndrome is reviewed.

[Protocol proposal for the histological report of the primary tumor in patients with cutaneous melanoma from the Task Force for Cutaneous Melanoma of the Valencian Community]. / Propuesta de protocolo para el informe histológico del tumor primario de los pacientes con un melanoma cutáneo del Grupo de Trabajo para el Melanoma Cutáneo de la Comunidad Valenciana.

This text compiles a histological protocol proposal for cutaneous melanoma agreed by the Task Force for Cutaneous Melanoma of the Valencian Community. It brings together the protocol itself and, in addition, includes a description of each of the proposed variables that has shown to have a greater prognostic impact in previous works.

Onychopathy in a patient with fetal hydantoin syndrome.

Hydantoin is an anticonvulsant drug with several side effects. A teratogenic potential has been suggested. The fetal hydantoin syndrome is an entity that consists of a broad range of morphologic and developmental disorders in children born of epileptic mothers exposed to hydantoin during pregnancy. We treated a girl in whom onychopathy was a monosymptomatic or mild form of this syndrome.

Cutaneous hyalohyphomycosis caused by Paecilomyces lilacinus in an immunocompetent host successfully treated with itraconazole: case report and review.

Paecilomyces lilacinus is an emerging fungal pathogen that is highly resistant to many antifungal drugs. Skin and subcutaneous soft tissue infections caused by this organism are very unusual. Most cases occur in patients with impaired host defenses or following surgical procedures. There has been only one previous report of a histologically confirmed cutaneous infection due to Paecilomyces lilacinus in a patient without predisposing factors. Described here is the second histopathologically proven case of Paecilomyces lilacinus cutaneous infection in a healthy patient without any apparent portal of entry. Prolonged antifungal chemotherapy with itraconazole led to resolution of the skin lesion. This case of sporadic cutaneous infection due to Paecilomyces lilacinus is believed to be the first reported in Europe and the first histopathologically proven case successfully treated with itraconazole.

Estudio multicéntrico de casos y controles sobre factores de riesgo de desarrollar un melanoma cutáneo en la Comunidad Valenciana / Multicenter Case-Control Study of Risk Factors for Cutaneous Melanoma in Valencia, Spain

Introducción: En la población general es importante identificar aquellos subgrupos con un riesgo elevado de padecer un melanoma cutáneo, por la posibilidad de aplicar medidas preventivas y de detección temprana de la enfermedad. La mayoría de los estudios realizados que evalúan estos factores de riesgo tienen una aplicabilidad limitada en nuestro medio, debido a que las poblaciones estudiadas están sometidas a distintos factores ambientales y los rasgos pigmentarios son diferentes. Objetivos: Identificar qué características fenotípicas individuales y relacionadas con la exposición solar son factores de riesgo para desarrollar un melanoma cutáneo en la población de la Comunidad Valenciana. Métodos: Realizamos un estudio multiinstitucional observacional de casos y controles. Fueron incluidos 242 casos de melanoma incidentes tratados en 5 hospitales, y 173 controles recogidos entre los acompañantes de los pacientes entre enero de 2007 y junio de 2008. La información fue recogida mediante un cuestionario estandarizado y validado. Fue calculada la odds ratio (OR) para cada variable y ajustada mediante regresión logística múltiple. Resultados: Los fototipos I-II, el color de pelo rubio o pelirrojo, el color de ojos claro, la presencia de abundantes nevos melanocíticos y los antecedentes personales de queratosis actínicas o de cáncer cutáneo no melanoma fueron los factores de riesgo estadísticamente significativos. Tras el estudio multivariado solo el color de pelo rubio o pelirrojo (OR=1,9), la presencia de múltiples nevos melanocíticos (OR=3,1), los fototipos I-II (OR=2,1) y los antecedentes personales de queratosis actínicas (OR=3,5) o de cáncer cutáneo no melanoma (OR=8,1) se mantuvieron en el modelo como las variables predictivas independientes relacionadas con el desarrollo de melanoma. Conclusiones: Nuestro estudio apoya la importancia de una serie de factores que indican predisposición genética (color de pelo y fototipo) y ambientales relacionados con la exposición solar. Los pacientes con múltiples nevos melanocíticos adquiridos, y también aquellos con marcadores de daño solar crónico (queratosis actínicas y cáncer cutáneo no melanoma), presentaron un significativo aumento del riesgo (AU)

Introduction: It is important to identify subgroups within the general population that have an elevated risk of developing cutaneous melanoma because preventive and early-detection measures are useful in this setting. The findings of most studies that have evaluated risk factors for cutaneous melanoma are of limited application in Spain because the populations studied have different pigmentary traits and are subject to different environmental factors. Objective: To identify the phenotypic characteristics and amount of exposure to sunlight that constitute risk factors for cutaneous melanoma in the population of the Autonomous Community of Valencia, Spain. Methods: We performed a multicenter observational case-control study. In total, the study included 242 patients with melanoma undergoing treatment in 5 hospitals and 173 controls enrolled from among the companions of the patients between January 2007 and June 2008.The information was collected by means of a standardized, validated questionnaire. The odds ratio (OR) was calculated for each variable and adjusted using a multiple logistic regressionmodel. Results: The risk factors found to be statistically significant were skin phototypes I and II, blondor red hair, light eye color, abundant melanocytic nevi, and a personal history of actinic keratosisor nonmelanoma skin cancer. After the multivariate analysis, only blond or red hair (OR = 1.9), multiple melanocytic nevi (OR = 3.1), skin phototypes I and II (OR = 2.1), and a personal history of actinic keratosis (OR = 3.5) or nonmelanoma skin cancer (OR = 8.1) maintained significance in the model as independent predictive variables for melanoma. Conclusions: Our study supports the importance of certain factors that indicate genetic predisposition(hair color and skin phototype) and environmental factors associated with exposure to sunlight. Patients with multiple acquired melanocytic nevi and patients with markers of chronic skin sun damage (actinic keratosis and nonmelanoma cancer) presented a significant increase in risk (AU)