Melanonychia, melanocytic hyperplasia, and nail melanoma in a Hispanic population.

OBJECTIVE: Longitudinal melanonychia (LM) is a common dermatologic problem encountered in everyday practice. Its diagnostic approach is critical as it can be an early sign of nail melanoma. Racial melanonychia is the entity most frequently associated with LM. Because there are no clinical data regarding these associations in a Mexican population, we conducted a prospective study. METHODS: A total of 68 consecutive patients given the clinical diagnosis of LM were included and a nail biopsy was performed to determine its cause. RESULTS: Racial melanonychia was found in 48 cases (68%), 4 cases (5.7%) were associated with benign melanocytic hyperplasia, and 4 cases (5.7%) had a nail apparatus malignancy. LIMITATIONS: Dermatoscopy and immunohistochemical stains were not used. Incisional transverse nail matrix biopsies were performed when melanonychia affected the middle portion of the nail plate. CONCLUSION: LM is most commonly associated with racial melanonychia in the Mexican population, but in nearly 6% of cases it may be linked with nail apparatus malignancy. To our knowledge, this is the first time a study of this nature was performed in a mestizo Hispanic population.

[Mammary Paget's disease: case report and review of the literature]. / Enfermedad de Paget mamaria: comunicación de un caso y revisión de la literatura.

Paget's disease of the nipple is a superficial manifestation of an underlying breast malignancy. It has been reported in 1-3% of all breast carcinomas. The peak incidence is between 50 and 60 years. Its clinical presentation includes an unilateral, erythematous, slightly infiltrated scaly plaque and nipple retraction. Sero-sanguineous discharge may be observed. We here report a 51 year old woman who had an eight month history of an eritematous-squamous plaque with hematic scabs in the left nipple, with mild pruritus. A biopsy was taken and the diagnosis confirmed Paget's disease and intraductal breast carcinoma.

Enfermedad de Paget mamaria: comunicación de un caso y revisión de la literatura / Mammary Paget's disease: case report and review of the literature

La enfermedad de Paget mamaria (EP) es una manifestación superficial de enfermedad maligna de la mama. Suele presentarse entre 1 y 3% de todos los cánceres de mama y afecta principalmente mujeres entre los 50 y 60 años de edad. La forma clínica clásica se manifiesta con una placa infiltrada unilateral con eritema, escamas y en etapas avanzadas secreción del pezón o retracción del mismo. Presentamos el caso de una paciente de 51 años quién presentó dermatosis localizada a pezón izquierdo constituida por una placa eritemato-escamosa con costras hemáticas, de ocho meses de evolución, con prurito leve. Se le realizó biopsia y se diagnosticó enfermedad de Paget con carcinoma intraductal.

Paget's disease of the nipple is a superficial manifestation of an underlying breast malignancy. It has been reported in 1-3% of all breast carcinomas. The peak incidence is between 50 and 60 years. Its clinical presentation includes an unilateral, erythematous, slightly infiltrated scaly plaque and nipple retraction. Sero-sanguineous discharge may be observed. We here report a 51 year old woman who had an eight month history of an eritematous-squamous plaque with hematic scabs in the left nipple, with mild pruritus. A biopsy was taken and the diagnosis confirmed Paget's disease and intraductal breast carcinoma.

Treatment of nail bed defects with hard palate mucosal grafts.

BACKGROUND: Nail bed defects produce a nail plate dystrophy that is permanent and presents important cosmetic problems. To correct the defect, we used a hard palate mucosal graft. This is a procedure with encouraging outcomes for nail bed scars. OBJECTIVE: To show our initial experience with the hard palate mucosal graft technique for correcting nail dystrophy or permanent onycholysis secondary to a nail bed scar. METHODS: This was a prospective, longitudinal, descriptive, observational study. We included five patients with a traumatic nail bed scar and one patient with congenital dystrophy. Seven nails were treated using a hard palate mucosal graft. RESULTS: All repaired nails had a good outcome, with excellent growth and improvement in nail dystrophy. The patients had surgical recovery in 2 weeks and tolerable pain. CONCLUSIONS: This is a relatively easy procedure for experienced surgeons to correct nail dystrophy secondary to a nail bed scar, with good to excellent results.

Evaluation of subcision as a treatment for cutaneous striae.

BACKGROUND: Treatment options for cutaneous striae are very limited. OBJECTIVE: To determine if subcision is an effective treatment for cutaneous striae and compare a combination with 0.1% tretinoin cream against a single treatment. METHODS: 14 patients were evaluated, each with 3 white striae. One stria received treatment with subcision, one with tretinoin cream in a 0.1% concentration, and one with subcision plus tretinoin. The length of follow-up was 3 months. Two blind investigators evaluated improvement by comparison of the initial and final digital photographs. RESULTS: Only 7 patients completed 3 months follow-up. A decrease of width and clinical improvement was observed with the 3 treatments. However, some striae showed no change at all and there was no statistically significant difference between treatments. Three patients presented necrosis in striae treated with subcision. CONCLUSIONS: There are no studies in the medical literature about subcision for the treatment of cutaneous striae. This is a preliminary study and considering the undesirable effects of necrosis in a high percentage of striae treated with subcision, the subjective way of evaluation, and the small study group, we can not recommend subcision as a treatment for cutaneous striae. Large studies are necessary to corroborate or to discard our findings.

Surgical option for nonmelanoma skin cancer.

BACKGROUND: Basal cell carcinoma (BCC) is one of the most frequent malignancies in the general population. Its best treatment option is the complete excision of the lesion. Mohs' micrographic surgery has demonstrated to be the surgical method with the highest cure rates, however, it is not available in many countries or institutions. METHODS: We propose, as a treatment option for high-risk BCC, surgical resection of the tumor with transoperatory histological examination with the hematoxilin-eosin technique, delaying closure of the wounds until the margins and surgical bed are tumor-free. RESULTS: We studied 83 patients with BCC; 49 were treated with the transoperatory technique and delay closure. We observed no recurrence in any patient that we followed up and there were no complications resulting from the technique in a 25-month follow up. CONCLUSIONS: We recommend this technique for tumors with high-risk of recurrence if Mohs' micrographic surgery is not available.