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.

[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.

[Oral hairy leukoplakia. A study of 5 cases]. / Leucoplasia vellosa oral. Estudio de cinco casos.

Oral hairy leukoplakia (HL) is a newly described lesion (1984) in human immunodeficiency virus infected patients. Patients with HL show a high probability of developing an acquired immunodeficiency syndrome (AIDS). The results of histopathological, microbiological, immunological and ultrastructural studies in five patients with HL and AIDS are reported. The histopathological exam revealed in all cases acanthosis, parakeratosis, koilocytosis and keratin projections on the surface. Dermis was normal. Herpes type virus were seen in four cases and in one of them papilloma virus was also present in electron microscopic examination. There was immunocytochemical evidence of papilloma virus in one lesion. Candida albicans was found in 5 lesions by culture but only in two ones by periodic acid Schiff stain. Virus cultures for herpes virus were negative. Immunocytochemical search of Langerhans cells (S-100, HLA-DR, OKT4, OKT6) showed nearly absence of these cells in HL lesions. These results favour the viral etiology hypothesis of hairy leukoplakia.

[Lupus erythematosus panniculitis presenting as palpebral edema and parotiditis]. / Edema palpebral y parotiditis como forma de presentación de la paniculitis lúpica.

Lupus erythematosus panniculitis or lupus erythematosus profundus is characterized by inflammation of the deep dermis and subcutaneous tissue. It can occur in isolation or associated with chronic systemic or discoid lupus erythematosus. It usually consists of nodules and hardened subcutaneous plaques on the forehead, cheeks, proximal extremities, and buttocks. Periorbital and parotid involvement are rare and can lead to misdiagnosis. We present the case of a patient with lupus erythematosus panniculitis who presented with palpebral edema and involvement of the periocular fat and parotid gland.

[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.

Immunohistochemical localization of filaggrin in benign, premalignant and malignant cervical tissue.

Epithelial distribution of filaggrin, a histidine-rich protein related to squamous terminal differentiation, was investigated in 87 cervical biopsies using an avidin-biotin-peroxidase technique with a monoclonal anti-human filaggrin antibody (AKH1). Normal squamous cervical epithelium exhibited a positive homogeneous immunoperoxidase stain in the upper parabasal, intermediate and superficial cell layers. Similar findings were obtained in cervical condylomas, although full-thickness staining was observed in 35.7% of the cases (P < 0.001). Filaggrin expression in CIN was inversely related to the severity of the lesion (P < 0.001). An irregular staining pattern was present in most high-grade CIN. Filaggrin expression was closely connected to the degree of tumour differentiation (P < 0.05) in squamous cell carcinomas of the cervix. Abnormal filaggrin stainings identified a premalignant/malignant cervical squamous lesion with a positive predictive value of 92.3%. Non-squamous epithelia showed lack of filaggrin expression. Filaggrin may therefore be considered a marker of squamous differentiation in both the normal and pathological human uterine cervix.

Distribution of epithelial antigens in the human uterine cervix: a review.

Epithelial antigen immunostaining in the uterine cervix has been claimed to be helpful in the identification and classification of rare lesions, evaluation of basement membrane integrity, study of atypical condylomas, immunodetection of proliferating processes and early diagnosis of malignant transformation. The present review attempts to demonstrate the potential value of immunohistological techniques as a means of identifying normal and abnormal patterns of antigenic expression in cervical epithelium.

Precocious appearance of markers of squamous differentiation in metaplastic cells of human endocervix.

We used immunoperoxidase methods employing antibodies against involucrin and filaggrin, both markers of squamous terminal differentiation, to study squamous metaplastic transformation in the human endocervix. Expression of involucrin and filaggrin was restricted to squamous metaplastic cells whereas columnar epithelial cells were constantly negative. Immature squamous metaplastic epithelium also showed a positive immunostaining. In mature squamous metaplasia a suprabasal homogeneous staining pattern similar to that found in the exocervical epithelium was detected, although with full-thickness filaggrin immunoreactivity in 45% of cases (P less than 0.05). These results support the hypothesis of an epithelial origin of reserve subcolumnar cells, and suggest that precocious squamous differentiation seems to take place in metaplastic cells of the human endocervix.

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)

Edema palpebral y parotiditis como forma de presentación de la paniculitis lúpica / Lupus erythematosus panniculitis presenting as palpebral edema and parotiditis

La paniculitis lúpica o lupus profundo se caracteriza por la afectación inflamatoria de la dermis profunda y el tejido celular subcutáneo. Puede aparecer de forma aislada o en el contexto de un lupus eritematoso sistémico o discoide crónico. Habitualmente consiste en nódulos y placas subcutáneas induradas localizadas en frente, mejillas, zona proximal de extremidades y nalgas. Otras localizaciones como la periorbitaria y parotídea son muy infrecuentes y pueden llevar a errores diagnósticos. Presentamos el caso de un paciente con paniculitis lúpica con afectación palpebral y de la grasa periocular y periparotídea

Lupus erythematosus panniculitis or lupus erythematosus profundus is characterized by inflammation of the deep dermis and subcutaneous tissue. It can occur in isolation or associated with chronic systemic or discoid lupus erythematosus. It usually consists of nodules and hardened subcutaneous plaques on the forehead, cheeks, proximal extremities, and buttocks. Periorbital and parotid involvement are rare and can lead to misdiagnosis. We present the case of a patient with lupus erythematosus panniculitis who presented with palpebral edema and involvement of the periocular fat and parotid gland