Caracterización de pacientes con cáncer de piel y otras afecciones causadas por fotodaño / Characterization of patients with skin cancer and other affections caused by photodamage

Introducción: El fotodaño es la agresión producida por la radiación solar en la piel. A su vez, la radiación ultravioleta es uno de los primeros agentes considerados como generadores de cáncer. Objetivo: Caracterizar a los pacientes con neoplasias cutáneas y otras afecciones causadas por fotodaño, según variables clínicas seleccionadas. Métodos: Se realizó un estudio transversal, observacional, clínico, descriptivo y retrospectivo de 64 pacientes diagnosticados con alguna afección causada por fotodaño, pertenecientes al área de salud del consultorio médico No. 11 del Policlínico Aquiles Espinosa Salgado de Las Tunas, desde enero del 2020 hasta igual periodo del 2022. Se analizaron variables, tales como edad, sexo, color de la piel, fototipo de piel, ocupación, uso regular de medios de protección solar antes de los 18 años de edad y actualmente, así como enfermedad dermatológica causada por fotodaño. Resultados: Predominaron el grupo etario de 60 años y más (43,7%), el sexo femenino (54,7 %), el color de la piel blanco (98,5 %), el fototipo de piel III (59,4 %) y los trabajadores estatales (53,1%).Se halló, que 90,6 % de los pacientes no tenían antecedentes de exposición a radiaciones no ultravioletas; 25,0 % refirió usar regularmente algún medio de protección antes de los 18 años de edad y 51,5 % lo emplean actualmente. La enfermedad dermatológica causada por fotodaño que primó fue el cáncer de piel (37,5 %). Conclusiones: Este estudio denotó la pertinencia y necesidad de identificación de las características clínicas de los pacientes con afecciones causadas por fotodaño en el consultorio médico referido.

Introduction: Photodamage is the aggression caused by solar radiation in the skin. In turn, the ultraviolet radiation is one of the first agents considered as cancer generators. Objective: Characterize the patients with cutaneous neoplasms and other affections caused by photodamage, according to selected clinical variables. Methods: A cross-sectional, observational, clinical, descriptive and retrospective study of 64 patients diagnosed with some affection caused by photodamage was carried out, belonging to the health area of the doctor office No. 11 of Achiles Espinosa Salgado Polyclinic in Las Tunas, from January, 2020 to the same period in 2022. Some variables were analyzed, such as age, sex, color of the skin, skin photo type, occupation, regular use of solar protection means before the 18 years and now, as well as dermatologic disease caused by photodamage. Results: There was a prevalence of the 60 years and over age group (43.7 %), female sex (54.7 %), color of the skin white (98.5 %), skin photo type III (59.4 %) and the state workers (53.1 %). It was found that 90.6 % of the patients didn't have history of exhibition to non ultraviolet radiations; 25.0 % referred to use some means of protection regularly before the 18 years and 51.5 % use it at the moment. The dermatologic disease caused by photodamage that prevailed was the skin cancer (37.5 %). Conclusions: This study denoted the relevance and necessity to identify the clinical characteristics of the patients with affections caused by photodamage in the doctor office abovementioned.

Laser therapy and light sources for labial lentigines in patients with Peutz-Jeghers syndrome.

Labial lentigines associated with Peutz-Jeghers syndrome are challenging and represent a cosmetic problem. Laser and intense-pulsed light sources (IPLS) can be used to treat these macules. However, there are few guidelines regarding the different types of protocols found in the literature. Thus, the purpose of this study was to review the pertinent literature on lasers and IPLS as therapy for labial lentigines in patients with Peutz-Jeghers syndrome. A detailed literature search was conducted in seven databases (Cochrane Library, Embase, Lilacs, PubMed, SciELO, Scopus and Web of Science) to November 2020. Data were extracted and analyzed from selected studies including study design, sample size, participants' skin color, age, and gender, parameters of the laser or IPLS used, interval and total sessions of laser application, results obtained, follow-up time and side effects. Thirteen out of 124 published studies met our eligibility criteria, covering 81 patients. Ten types of lasers and IPLS were used, and most of the sample (n = 57) was treated with Q-switch Alexandrite Laser (QSAL). The total number of sessions ranged from 1 to 12 and the interval between sessions ranged from 2 to 16 weeks. All studies have shown satisfactory results, with no further complications. The follow-up ranged from 2 to 97 months. Laser therapy and IPLS are effective in the treatment of lentigines associated with PJS. Although QSAL was used in 70.3% of the sample, different types of lasers showed comparable satisfactory results.

Extrafacial Lentigo Maligna: A Clinical And Dermoscopic Analysis According to Localization.

INTRODUCTION: Whether extrafacial lentigo maligna (EFLM) differs clinically and/or dermoscopically according to location has not been analyzed in depth. OBJECTIVES: To evaluate clinical and dermoscopic characteristics regarding different localization in a series of EFLM. METHODS: We conducted a retrospective analysis of clinical and dermoscopic characteristics of 69 histologically proven EFLM retrieved from the database of two private institutions. RESULTS: Of the 69 EFLM included in the study, 25 (36.2%) were located in posterior trunk (PT), 16 (23.2%) in anterior trunk (AT), 15 (21%) in upper extremities (UE), and 13 (18.8%) in lower extremities (LE). Mean diameter among localization were as follows: 14.3 mm in PT, 11.8 mm in AT, 14 mm in UE, and 10 mm in LE (p 0.44). The most frequent dermoscopic criteria were angulated lines and tan structureless areas (70%), followed by atypical pigment network (60%), both with similar distribution among groups. Angulated lines pattern was the most frequent global pattern, observed in 55% of cases. Tan structureless/granularity pattern and patchy peripheral pigmented islands pattern were seen in 15.6% and 11.6% cases, respectively. No statistically significant differences were observed in the distribution of global dermoscopic pattern in the different localizations. CONCLUSIONS: From the clinical point of view, EFLM did not differ in terms of patient's age and diameter regarding localization. Upon dermoscopy, we found no significant differences in the overall dermoscopic pattern in the different localizations.

Laser Q-Switched para o tratamento da melanose labial na síndrome de Peutz-Jeghers / Q-Switched Laser for the treatment of mucocutaneous pigmentation on Peutz-Jeghers Syndrome

A síndrome de Peutz-Jeghers (SPJ) é uma doença autossômica dominante, rara, em que há mutação no gene supressor tumoral, havendo maior predisposição para neoplasias, principalmente do trato gastrointestinal. As primeiras manifestações iniciam-se na infância com a presença de melanose mucocutânea e, posteriormente, surgem os pólipos hamartomatosos gastrointestinais. Apresentaremos o caso de uma paciente feminina, jovem, cujas manifestações iniciais da SPJ iniciaram-se na infância sob a forma de melanose cutânea. O tratamento dessas lesões foi realizado com três sessões com os lasers Nd:YAG Q-Switched 1064nm e KTP Q-Switched 532nm, evoluindo com excelente resposta terapêutica e sem recidiva

Peutz-Jeghers syndrome (PJS) is a rare, autosomal dominant disease where there is a mutation in the tumor suppressor gene, with a greater predisposition to neoplasms, especially of the gastrointestinal tract. The first manifestations begin during childhood with the presence of mucocutaneous melanosis and, later, gastrointestinal hamartomatous polyps. We describe a case of a young woman whose initial PJS manifestation started during her childhood with cutaneous melanosis. Three sessions with the Q-switched 1064nm Nd:YAG and 532nm KTP lasers were performed to treat the melanosis with excellent results and without recurrence.

Pigmented lesion on the face: which is the chance of being melanoma using reflectance confocal microscopy features?

Facial melanoma presents itself as a brownish macula, being difficult to differentiate it from benign pigmented lesions of the face on clinical examination. Reflectance confocal microscopy (RCM) assists in diagnosing facial lesions in which dermoscopy has limitations, allowing to increase the diagnostic accuracy. The study aimed to analyze the RCM features of pigmented isolated lesions of the face for diagnosing melanoma. Also, we sought to establish the chance of a pigmented lesion on the face being a melanoma using RCM criteria. In this retrospective and prospective study, 105 clinical pigmented lesions on the face underwent RCM, and cytoarchitectural features in the epidermis, the dermo-epidermal junction (DEJ), and dermis were described. For statistical analysis, the exact chi-square test was applied to the RCM criteria. The odds ratio was estimated using univariate logistic regression. Finally, we used the multiple logistic regression method for creating a nomogram to predict the chance of a lesion being a melanoma. After univariate and multivariate logistic regression, atypical round nucleated cells within the epidermis, pagetoid spread, and follicular dendritic cells presented as statistically significant features. Then, a complex nomogram was created to give the chance of a pigmented lesion on the face being a melanoma. The presence of these three features resulted in a 98% probability for melanoma. This study allowed to estimate the diagnosis of melanoma on the face, using RCM, practicable and feasible in the daily routine, through the presence of some RCM nomogram criteria.

Caracterización clínico-epidemiológica de pacientes con daño actínico crónico. Cochabamba, Bolivia / Clinical-epidemiological characterization of patients with chronic actinic damage. Cochabamba, Bolivia

RESUMEN Introducción: el daño actínico crónico es un grupo de alteraciones en la estructura, función y apariencia de la piel como resultado de la exposición no controlada a las radiaciones ultravioletas. Puede provocar el cáncer de piel. Objetivo: caracterizar a los pacientes con daño actínico crónico, atendidos en la consulta de Dermatología del Hospital Comunitario Valle Hermoso, en el departamento de Cochabamba, Bolivia. Materiales y métodos: se realizó un estudio clínico descriptivo, prospectivo, en un universo de 1 833 pacientes diagnosticados con daño actínico crónico, atendidos en la consulta de Dermatología del Hospital Comunitario Valle Hermoso, en Cochabamba, entre septiembre de 2017 y septiembre de 2018. Se evaluaron las variables edad, sexo, color y fototipo de piel, ocupación, uso de medios de protección solar, exposición a otro tipo de radiaciones, manifestaciones clínicas de fotodaño y altitud del lugar de residencia. Resultados: predominaron el grupo de edad de 25 a 59 años, el sexo femenino, el color de piel mestizo (77,08 %), el fototipo de piel IV (76,98 %) y la ocupación comerciante (72,56 %). La mayoría de los pacientes (82,7 %) no utilizaron medios de protección solar, y el 99,8 % no tuvieron exposición a otro tipo de radiaciones. Las lesiones por fotodaño que prevalecieron fueron melasma (83,03 %) y lentigos (12,22 %). El 99,29 % vivían en zonas de gran altitud. Conclusiones: se caracterizaron los pacientes con daño actínico crónico, obteniendo en algunas variables estudiadas resultados similares a los mencionados por otros investigadores (AU).

ABSTRACT Introduction: chronic actinic damage is a group of alterations in the structure, function, and appearance of the skin as a result of uncontrolled exposure to ultraviolet radiation. It can cause skin cancer. Objective: to characterize the patients with chronic actinic damage, treated at the Dermatology consultation of Valle Hermoso Community Hospital, in the department of Cochabamba, Bolivia. Materials and methods: a descriptive, prospective clinical study was conducted in a universe of 1,833 patients diagnosed with chronic actinic damage, treated at the Dermatology clinic of the Valle Hermoso Community Hospital, Cochabamba, between September 2017 and September 2018. The variables age, sex, skin color, skin phototype, occupation, use of sun protectors, exposure to other types of radiation, clinical manifestations of photodamage and altitude of the place of residence were evaluated. Results: the age group from 25 to 59 years, the female sex, mestizo skin color (77.08 %), the IV skin phototype (76.98 %) and merchant occupation (72.56 %) predominated. Most patients (82.7 %) did not use sun protection means, and 99.8 % had no other radiation exposure. The prevailing photodamage lesions were melasma (83.03 %) and lentigo (12.22 %). 99.29 % lived in high altitude areas. Conclusions: the patients with chronic actinic damage were characterized, obtaining in some variables studied results similar to those mentioned by other researchers (AU).

Clinical size is a poor predictor of invasion in melanoma of the lentigo maligna type.

BACKGROUND: There are no well-defined clinical factors to predict the risk of occult invasion in melanoma of the lentigo maligna type (LM) before complete histopathologic analysis. OBJECTIVE: To evaluate whether clinical size was a predictor of invasion in LM and subclinical extension. METHODS: Consecutive cases of LM were recorded in a prospectively maintained database from 2006 to 2019. Patient and tumor data were recorded during initial evaluation. The LM clinical area was calculated in square millimeters (length × width). All patients were treated with staged excision. RESULTS: We included 600 patients. The mean age was 65.9 years (standard deviation, 12.3; range, 27-95 years); 62.8% (n = 377) were men. The mean LM clinical area was 128.32 mm2 for in situ lesions versus 200.14 mm for invasive lesions (P = .1). Based on quantile regression, the median margin required for complete removal increased with LM clinical area. LIMITATIONS: The study was performed in a tertiary cancer center with possible referral bias and more complex cases. CONCLUSIONS: LM can present with variable clinical size, which may correlate with subclinical extension; however, the presence of invasion is not well estimated by LM clinical area.

Associação de luz intensa pulsada e laser Erbium: Yag 2940nm para tratamento de lentigo na face / Association of intense pulsed light and Erbium: Yag 2940 nm laser for treatment of lentigo on the face

O lentigo solar está presente em 90% da população com mais de 50 anos de idade, apresentando-se como manchas hipercrômicas em regiões fotoexpostas, que aumentam com o envelhecimento e são mais frequentes em peles claras. Há diversas modalidades terapêuticas com melhores resultados quando associadas. Descrevemos o caso de um homem de 62 anos, fototipo II de Fitzpatrick, com queixa de máculas acastanhadas em dorso nasal há oito anos. Foi submetido à biópsia de pele, e o estudo histológico confirmou ser lentigo solar. O paciente foi tratado com seis sessões de luz intensa pulsada associada a laser de Erbium: YAG 2940nm, com bom resultado clínico

Solar lentigo is present in 90% of the population over 50 years of age andcharacterizes as hyperchromic spots in photoexposed regions. It increases with aging and is more frequent in light skin. There are several therapeutic modalities, which achieve better results whenassociated. We describe the case of a 62-year-old man with Fitzpatrick skinphototype II, complaining of brownish macules in nasal dorsum for eight years. The patient underwent a skin biopsy, and the histological study confirmed solar lentigo. The patient was treated with six sessions of Intense Pulsed Light associated with Erbium-Yag2940 nm Laser with a good clinical result

Biópsia por saucerização para diagnóstico diferencial de lentigo maligno na face e no couro cabeludo: abordagem diagnóstica / Shave biopsy for differential diagnosis of lentigo maligna on the face and scalp: diagnostic approach

Introdução: O lentigo maligno é um subtipo de melanoma in situ que acomete áreas de intenso dano solar. Na face, ele pode ter aspecto clínico e dermatoscópico semelhante a diversas lesões pigmentadas benignas. O diagnóstico diferencial entre elas é fundamental para abordagem terapêutica adequada e deve, preferencialmente, ser feito pela análise histopatológica. A biópsia excisional é o padrão ouro, porém em lesões grandes, irressecáveis ou em locais de difícil abordagem ela pode gerar grande prejuízo estético e funcional. Nesses casos, a biópsia por saucerização parece ser uma alternativa segura e fidedigna. Objetivo: Descrever a técnica adequada da saucerização, discutir seus resultados e suas indicações na rotina ambulatorial do dermatologista. Métodos: Foram selecionados 16 pacientes com suspeita de lentigo maligno na face e no couro cabeludo. Os critérios de inclusão foram idade maior que 18 anos, ausência de diagnóstico e tratamentos prévios, lesões planas, maiores que 8mm e com sinais clínicos e dermatoscópicos sugestivos. A abordagem realizada foi biópsia por saucerização. Resultados: O diagnóstico de lentigo maligno foi confirmado em 25% dos casos, e a ampliação de margens apresentou resultado compatível em 100% deles. Conclusões: A biópsia por saucerização parece ser uma alternativa adequada para lesões planas sem evidências clínicas e dermatoscópicas de crescimento vertical.

Introduction: Lentigo maligna is a subtype of melanoma in situ, which affects sun-exposed areas. On the face, it can have a clinical and dermoscopic appearance similar to several benign pigmented lesions. Differential diagnosis between them is fundamental for the appropriate therapeutic and should be made by histopathological analysis. Excisional biopsy is the gold standard, but in large, unresectable lesions or in difficult anatomical sites, it can have aesthetic or functional implications. In these cases, shave biopsy appears to be a safe and reliable alternative. Objective: To describe an appropriate shave biopsy technique, discuss its results and indications in the outpatient routine of the dermatologist. Methods: Sixteen patients with suspected : Lentigo maligna on the face and scalp were selected. Inclusion criteria were older than 18 years, lack of diagnosis and previous treatment, flat lesions larger than 8 mm and suggestive clinical and dermatoscopic signs. The approach performed was shave biopsy. Results: The diagnosis of : Lentigo maligna was confirmed in 25% of the cases, and a widening of margins presented compatible results in 100% of them. Conclusions: Shave biopsy seems to be a suitable alternative for flat lesions without clinical and dermoscopic criteria of vertical growth.

Lentigo maligno tratado con imiquimod 5%. Presentación de un caso y revisión del tema / Malignant Lentigo treated with imiquimod 5%. Presentation of a case and review of the subject

Resumen El lentigo maligno (LM) es una variante de melanoma in situ que se desarrolla principalmente en áreas de exposición solar crónica en pacientes de etnia blanca, de edad media-avanzada. Sin tratamiento, del 5% hasta el35% de los LM pueden progresar a un melanoma lentigo maligno (LMM). Aunque el tratamiento de elección es quirúrgico, el imiquimod aparece como una opción no invasiva viable. Suele indicarseen pacientes con tumores de gran tamaño, personas de edad avanzada o con patología de base, o que simplemente rechazan la extirpación quirúrgica de la lesión, especialmente por ser desfigurante. Se presenta una paciente con LM tratada satisfactoriamente con imiquimod tópico.

Abstract Malignant lentigo (LM) is a variant of in situ melanoma that develops mainly in areas of chronic sun exposure in middle-aged patients. Without treatment, 5% to 50% of the LM can progress to a lentigo maligna melanoma (LMM). Although the treatment of choice is surgical, imiquimod seems to be a viable and non-invasive option in patients with large tumors, elderly or people with underlying disease, or who simply reject the surgical removal of the lesion. We present a case of LM satisfactorily treated with topical imiquimod.

Clinical usefulness of dermoscopy in the management of lentigo maligna melanoma treated with topical imiquimod: A case report.

The importance of dermoscopy for diagnosing lentigo maligna melanoma (LMM) is well known. More recently, dermoscopy has been proposed as a useful tool also for the treatment choice and monitoring. Herein, we present an 87-year-old woman, who was successfully treated with imiquimod 5% cream after surgical persistence of residual LMM and for whom dermoscopy was helpful to assist diagnosis and assess tumor persistence after surgery and its response to topical treatment with imiquimod.

Lentigo maligno palpebral: o manejo com a interface Dermatologia-Oculoplástica: a propósito de um caso / Lentigo maligna of the eyelid: management with Dermatology-Oculoplastic interface: for the purpose of a case

Apresentou-se à consulta um paciente masculino de 74 anos, portador de uma mancha hiperpigmentada junto à borda palpebral inferior esquerda, com cores variadas, entre diferentes matizes de marrom; a biópsia confirmou o diagnóstico de lentigo maligno. A sua localização na borda palpebral é rara. Há alguma divergência na literatura quanto ao melhor método para seu tratamento. Opções terapêuticas não cirúrgicas, como o imiquimode, têm sido apresentadas bem como diferentes variantes no manejo cirúrgico e nas margens requeridas. No caso descrito, optou-se por manejo com margens conservadoras, preservando-se a funcionalidade da área.

74-year-old male patient came to medical consultation presenting a hyperpigmented stain near the lower left eyelid edge, with varying colors, between different shades of brown; the biopsy confirmed the diagnosis of lentigo maligna. Its location on the eyelid edge is rare. There is some divergence in the literature regarding the best method for its treatment. Non-surgical therapeutic options, such as imiquimod, have been suggested, as well as different variants in surgical management and required margins. In the case described, it was chosen to manage with conservative margins, preserving, the functionality of the area.

Uso da técnica em "spaghetti" para tratamento cirúrgico do lentigo maligno / Use of the "spaghetti" technique for surgical treatment of lentigo maligna

O lentigo maligno (LM) é uma forma de melanoma in situ que mais comumente se apresenta como uma mácula de crescimento lentamente progressivo, pigmentada, na face de idosos com pele danificada pelo sol. Esse melanoma in situ tem um risco (30% a 50%) de progressão para lentigo maligno melanoma. A excisão cirúrgica completa da lesão requer margens de pelo menos 10mm, mesmo para lesões in situ. Porém, quando o crescimento de LM ocorre em áreas de implicações estéticas ou funcionais (face, pescoço, solas), a excisão é frequentemente reduzida para preservar estruturas anatômicas importantes e por razões cosméticas. Além disso, as margens periféricas podem ser clinicamente mal definidas e nem sempre pigmentadas, com extensão subestimada e risco de ressecção insuficiente. A "técnica de espaguete", descrita por Gaudy Marqueste, é uma cirurgia estratégica baseada na amostragem de uma faixa de tecido "spaghettilike" para determinar as margens da lesão antes da remoção do tumor. Após a confirmação anatomopatológica de margens livres de neoplasia, a lesão principal central é ressecada, permitindo a reconstrução do defeito no mesmo procedimento, sendo uma alternativa à cirurgia micrográfica de Mohs.(AU)

Lentigo maligna (LM) is a melanoma in situ that commonly presents as a macula with progressive and irregularly pigmented growth, especially in the face of elderly people with sun-damaged skin. This melanoma in situ has a risk (30-50%) of progression to lentigo maligna melanoma. Complete surgical excision of the lesion requires margins of at least 10 mm, even for lesions in situ. However, when the growth of LM occurs in areas of aesthetic or functional implications (face, neck, and soles), the excision is often reduced to preserve important anatomic structures and for cosmetic purposes. Moreover, the peripheral margins may be clinically ill-defined and not always pigmented, and thus, such cases are associated with underestimated extension and risk of insufficient resection. The "spaghetti" technique, described by Gaudy Marqueste, is a strategic surgical approach based on sampling of a range of "spaghetti-like" strips to determine the margins of the lesion prior to removal of the tumor. After the pathological confirmation of neoplasia-free margins, the main central lesion is resected, allowing reconstruction of the defect in the same procedure, as an alternative to Mohs micrographic surgery. (AU)

Melanoma lentigo maligno amelanótico / Amelanotic lentigo maligna melanoma

RESUMEN El melanoma lentigo maligno es un subtipo de melanoma invasor, que se localiza en áreas fotodañadas de cara y cuello, manifestándose como una mácula no muy definida, de varios colores de la gama del marrón y negro. La variante amelanótica es infrecuente en cualquiera de los subtipos cutáneos de melanoma. Presentamos el caso de una mujer de 63 años, que presentó un melanoma lentigo maligno de subtipo amelanótico y de localización infrecuente, en miembro inferior.

SUMMARY Lentigomalignamelanoma is a subtype of invasive melanoma, located in photodamaged skin, particularly of the face and neck. It appears as an ill- defined macula, of heterogeneous color, ranging from brown to black. The amelanotic variant is infrequent in any of the cutaneous melanoma subtypes. We report the case of a 63-year-old woman with amelanoticlentigomaligna melanoma, located in her lower right limb.

Dermal vasculature and melanocytic proliferation index in photodamaged skin in the assessment of lateral margins of lentigo maligna and lentigo maligna melanoma.

Lentigo maligna (LM) is the most common subtype of melanoma on the face. When it invades the dermis it is called lentigo maligna melanoma (LMM). Its histological delimitation is controversial due to subjectivity. Analysis of peritumoral vasculature and proliferation index of melanocytes may help to differentiate tumor areas from tumor-free areas, as neoplasia-induced angiogenesis in such scenarios, as well as the higher proliferation index of melanocytes in melanomas, are well established. This work compares the peritumoral vasculature and melanocyte proliferation index of LM and LMM with that of adjacent non-neoplastic skin and sun-damaged skin (control). Forty-three resection cases of LM and LMM were selected retrospectively. Immunohistochemistry was performed for anti-CD31 and anti-CD105 to assess vascularization. Melanocyte proliferation index double labeling was performed using the anti-Melan-A and anti-Ki-67. The Chalkley optical grid was used to quantify blood vessel hotspots. Doubly labeled cells with anti-Melan-A and anti-Ki-67 were counted at tumor, free margin, and control skin. Microvasculature quantification under the melanomas, for both CD31 and CD105, was greater than at the margins of the same specimens (P < 0.0001; P = 0.0001) and greater than control skin (P = 0.0016; P = 0.0027), with higher density for CD31 than CD105. The mean number of double-labeled proliferating melanocytes at the melanoma periphery was greater than at the adjacent free skin and control skin (P = 0.0011). The control skin samples showed the highest CD31-positive vasculature in the head and neck region, with a positive correlation between melanocytic proliferation index and vasculature. The presence of neovascularization (CD105) and proliferating melanocytes (Ki67+/Melan-A+) are suspicious findings for LM/LMM, helping to outline, diagnose, and evaluate tumor margins.

[Overlap syndrome. LEOPARD and neurofibromatosis. A case report]. / Síndrome de superposición. LEOPARD con neurofibromatosis. Reporte de caso.

We expose a clinical case of a 43-year-old patient who was attended at the Dermatology service in a general hospital of the Instituto Mexicano del Seguro Social, with a disseminated pattern of lentigines, psychomotor retardation and electrocardiographic abnormalities. Afterwards, we made an analysis of the literature.

Se presenta el caso de un paciente varón de 43 años de edad, que fue atendido en el servicio de Dermatología de un hospital general de zona del Instituto Mexicano del Seguro Social, con lesiones lentiginosas diseminadas, retraso psicomotor y alteraciones electrocardiográficas. Posteriormente, realizamos un análisis de la literatura.

Melanoma in situ and syringoma: a rare collision tumor. Clinical-pathological report of a case

Abstract Collision or contiguous tumors, defined as two or more distinct tumors occurring at one site, are often an unexpected finding and may represent a diagnostic challenge, as clinical and histological presentations do not always coincide. Various combinations of collision tumors have been described with respect to melanocytic lesions, with the most frequently reported being the combination of nevus and basal cell carcinoma. We present an unusual case on the nose involving a melanoma in situ and a clinically-inapparent syringoma, which, to the best of our knowledge, is the first report of this combination.

Melanoma lentiginoso acral en una paciente adulta / Acral lentiginous melanoma in an adult patient

Se presenta el caso clínico de una paciente ecuatoriana de 58 años, blanca, con antecedentes de hernias discales en regiones cervical y lumbar, quien hace 2 años asistió a la Consulta de Dermatología por presentar cambio de coloración en la uña del tercer dedo de la mano derecha, síntomas que se correspondían con un lentigo simple. En esta ocasión acude con destrucción de la lámina ungueal y aumento de la coloración que se extiende a todo el pulpejo del dedo, por lo cual se le realizó otra biopsia y se confirmó el diagnóstico histológico de melanoma lentiginoso acral (in situ).

The case report of a 58 years white patient is presented with a history of disk herniation in cervical and lumbar regions, who 2 years ago attended the Dermatology Service due to a color change in the fingernail of the third finger of her right hand, symptoms that belonged to a lentigo simplex. In this occasion she presented destruction of the ungueal bed and increase of color which covers the whole fingertip, so another biopsy was carried out and the histological diagnosis of acral lentiginous melanoma (in situ) was confirmed.

Clinical and dermoscopic characteristics of melanomas on nonfacial chronically sun-damaged skin.

BACKGROUND: Melanomas on chronically sun-damaged skin (CSDS) can be difficult to identify and often manifest morphologic features that overlap with benign lesions. OBJECTIVE: We describe and analyze the clinical and dermoscopic characteristics of melanomas on nonfacial CSDS. METHODS: Melanoma cases on nonfacial CSDS were retrospectively identified from the biopsy specimen logs of 6 melanoma clinics. Clinical and dermoscopic images were combined into 1 database. Demographics, clinical, dermoscopic, and histopathologic information were analyzed. Descriptive frequencies were calculated. RESULTS: One hundred eighty-six cases met the inclusion criteria: 142 melanomas in situ (76%) and 39 invasive (21%; mean thickness, 0.49 mm). Lentigo maligna was the most common histopathologic subtype (n = 76; 40.9%). The most frequent dermoscopic structures were granularity (n = 126; 67.7%) and angulated lines (n = 82; 44%). Vascular structures were more frequent in invasive melanomas (56% vs 12% of in situ melanomas). Most manifested 1 of 3 dermoscopic patterns: patchy peripheral pigmented islands, angulated lines, and tan structureless with granularity pattern. LIMITATIONS: This was a retrospective study, and evaluators were not blinded to the diagnosis. In addition, interobserver concordance and sensitivity and specificity for dermoscopic structures were not evaluated. CONCLUSION: Outlier lesions manifesting dermoscopic structures, such as granularity, angulated lines, or vessels and any of the 3 described dermoscopic patterns should raise suspicion for melanoma.