Prognostic factors for satellitosis or in-transit metastasis in cutaneous squamous cell carcinoma: A multicentric cohort study.

BACKGROUND: Satellitosis or in-transit metastasis (S-ITM) has clinical outcomes comparable to node-positivity in cutaneous squamous cell carcinoma (cSCC). There is a need to stratify the risk groups. OBJECTIVE: To determine which prognostic factors of S-ITM confer an increased risk of relapse and cSCC-specific-death. METHODS: A retrospective, multicenter cohort study. Patients with cSCC developing S-ITM were included. Multivariate competing risk analysis evaluated which factors were associated with relapse and specific death. RESULTS: Of a total of 111 patients with cSCC and S-ITM, 86 patients were included for analysis. An S-ITM size of ≥20 mm, >5 S-ITM lesions, and a primary tumor deep invasion was associated with an increased cumulative incidence of relapse (subhazard ratio [SHR]: 2.89 [95% CI, 1.44-5.83; P = .003], 2.32 [95% CI, 1.13-4.77; P = .021], and 2.863 [95% CI, 1.25-6.55; P = .013]), respectively. Several >5 S-ITM lesions were also associated with an increased probability of specific death (SHR: 3.48 [95% CI, 1.18-10.2; P = .023]). LIMITATIONS: Retrospective study and heterogeneity of treatments. CONCLUSION: The size and the number of S-ITM lesions confer an increased risk of relapse and the number of S-ITM an increased risk of specific-death in patients with cSCC presenting with S-ITM. These results provide new prognostic information and can be considered in the staging guidelines.

Neutrophilic Infiltrates in Panniculitis: Comprehensive Review and Diagnostic Algorithm Proposal.

Neutrophilic infiltrates in panniculitis can be seen in different clinical-pathological entities. There are a "mostly neutrophilic inflammatory infiltrate" in some entities classically defined as neutrophilic panniculitis and already included in algorithms, such as enzymatic panniculitis, infective and factitial ones, erythema induratum, or subcutaneous Sweet syndrome, but there are also other panniculitis where neutrophils are frequently observed such as panniculitis associated with inflammatory bowel disease or rheumatoid arthritis, or drug-induced panniculitis associated with BRAF inhibitors, and finally, some panniculitis are better classified in other panniculitides groups but may present with neutrophil-rich variants, such as the neutrophil-rich subcutaneous fat necrosis of the newborn. We review the main clinical and histopathological features of most of these panniculitides and construct a diagnostic algorithm including these diseases.

[MALLEOLAR ULCERS ASSOCIATED TO HYDROXYUREA TREATMENT]. / Úlceras maleolares asociadas al tratamiento con hidroxiurea.

INTRODUCTION: Hydroxyurea (HU) is an antineoplastic drug used in chronic myeloproliferative disorders. In this article we will go into detail about the rare but serious appearance of lower limb ulcers in relation to HU treatment. METHODOLOGY: Two simultaneous cases are presented, both from patients with lower limb torpid lesions unresponsive to conventional treatments. After dismissing other aetiologies, HU was found to be the causal agent in both cases. DISCUSSION: In spite of HU's known correlation to lower limb ulcers, pathogenesis isn't clearly defined. In this article we add two more cases to the existing bibliography, with the goal of both insisting on the importance of integral valuation of patients with ulcers and contemplating dermatologic screening on patients treated with HU. CONCLUSION: HU laden ulcers are usually underdiagnosed. Integral valuation and dermatologic screening on patients are critical.

The use of tocilizumab in the treatment of refractory eosinophilic fasciitis: a case-based review.

Eosinophilic fasciitis (EF) is a rare disorder involving chronic inflammation of the fascia and connective tissue of unknown aetiology and poorly understood pathogenesis. We present the case of a 60-year-old man diagnosed with eosinophilic fasciitis with extensive cutaneous involvement and severe functional repercussion, which appeared weeks after suffering from pneumonia due to Legionella pneumophila. The patient did not experience any clinical response with high-dose corticosteroids, subcutaneous methotrexate, and intravenous immunoglobulins. Consequently, tocilizumab was initiated at 8 mg/Kg monthly achieving clinical response measured by a control MRI at the fifth dose. Response in terms of cutaneous thickness has been slower however favourable, therefore, more months of follow-up are necessary to assess the complete remission at skin level. EF treatment still constitutes a challenge, and experience with tocilizumab in the management of the disease is very limited. Through a systematic search of medical literature, we retrieved two cases describing EF treated with tocilizumab and several cases using another monoclonal antibody or Janus kinase inhibitor. We report the third case to our knowledge of the efficacy of tocilizumab in a refractory EF to corticosteroids and other immunosuppressive drugs.

Úlceras maleolares asociadas al tratamiento con hidroxiurea / Malleolar ulcers associated to hydroxyurea treatment

Introducción. La hidroxiurea (HU) es un reconocido agente antineoplásico utilizado desde hace años en síndromes mieloproliferativos crónicos. En este artículo ahondaremos en la poco frecuente pero grave aparición de úlceras en extremidades inferiores. Metodología. Presentamos dos casos simultáneos de pacientes con lesiones tórpidas en extremidades inferiores que no respondieron a tratamientos convencionales. Después de descartarse otras etiologías, se halló la HU como agente causal en ambos casos. Discusión. A pesar de que hace 30 años que se conoce la asociación entre HU y úlceras en extremidades inferiores, la patogénesis no está claramente definida. En este artículo añadimos dos casos más a la bibliografía ya existente, con el objetivo de insistir en la importancia de la valoración integral de los pacientes con úlceras y plantear un cribado dermatológico en pacientes en tratamiento con HU. Conclusión. Las úlceras secundarias a HU a menudo se infradiagnostican. Es importante la valoración integral y el cribado dermatológico en estos pacientes (AU)

Introduction. Hydroxyurea (HU) is an antineoplastic drug used in chronic myeloproliferative disorders. In this article we will go into detail about the rare but serious appearance of lower limb ulcers in relation to HU treatment. Methodology. Two simultaneous cases are presented, both from patients with lower limb torpid lesions unresponsive to conventional treatments. After dismissing other aetiologies, HU was found to be the causal agent in both cases. Discussion. In spite of HU’s known correlation to lower limb ulcers, pathogenesis isn’t clearly defined. In this article we add two more cases to the existing bibliography, with the goal of both insisting on the importance of integral valuation of patients with ulcers and contemplating dermatologic screening on patients treated with HU. Conclusion. HU laden ulcers are usually underdiagnosed. Integral valuation and dermatologic screening on patients are critical (AU)