'Rainbow pattern': a dermoscopic sign of invasive melanoma.

BACKGROUND: The 'rainbow pattern' was initially described as a highly specific dermoscopic feature of Kaposi sarcoma. Since then, it has been reported in many benign and malignant cutaneous tumours, including a few malignant melanomas (MMs). AIM: To determine the frequency and presentation of this dermoscopic pattern in primary cutaneous MMs in comparison to other cutaneous tumours. METHODS: The presence of a rainbow pattern was evaluated in a sample of 1100 dermoscopic images of different melanocytic and nonmelanocytic cutaneous neoplasms. RESULTS: The rainbow pattern was observed in 23 of 245 (9.4%) MM and 44 of 855 (5.1%) non-MM neoplasms. MMs presenting this feature were generally thicker: 82.6% > 1 mm and 43.0% > 2 mm. Compared with non-MMs, rainbow pattern in MMs was more commonly focal (82.7% vs. 36.4% nonfocal, P = 0.001) and associated with > 2 dermoscopic structures associated with MM (100% vs. 9% with fewer, P = 0.001). CONCLUSION: The rainbow pattern is a dermoscopic sign that can occasionally be observed in invasive MMs. In MMs, this feature is usually associated with other dermoscopic criteria of MM and located in a focal and eccentric area, as opposed to a diffuse and isolated presentation in non-MM neoplasms.

Prognostic significance of sentinel node biopsy status in cutaneous melanoma: a 21-years prospective study from a single institution.

AIM: To analyze the accuracy of the sentinel lymphatic node biopsy (SLNB) and to investigate predictive factors for sentinel node (SN) status and prognostic factors for recurrence-free survival (RFS) and disease-specific survival (DSS) in patients with melanoma. MATERIAL AND METHODS: Between June 1997 and June 2017, 440 consecutive patients, who underwent SLNB by a single surgical team, were prospectively included. Descriptive and survival analysis were performed. RESULTS: 119 of 440 patients (26%) had positive SN. SLNB's false-negative rate was 6.3%. Breslow thickness, Clark´s level, ulceration and histological subtype were statistically significant predictive factors of SN metastases. In a multivariate analysis, positive SN (HR = 2.21, p = 0.01), deeper Breslow thickness (HR = 2.05, p = 0.013), male gender (RR = 2.05, p = 0.02), and higher Clark's level (HR = 2.30, p = 0.043) were significantly associated with decreased RFS; and positive SN (HR = 2.58, p < 0.001), deeper Breslow thickness (HR = 2.57, p = 0.006) and male gender (HR = 1.93, p = 0.006) were associated with lower DSS. CONCLUSION: SLNB is a reliable and reproducible procedure with high sensitivity (93.7%). Positive SN metastases, Breslow thickness and male gender were statistically associated with poorer outcomes. Male gender was an independent prognostic factor of tumor thickness or SN status.

Liquen plano generalizado tratado con ultravioleta B de banda estrecha: resultados en 10 pacientes y revisión de la literatura / Generalized Licen Planus Treated With Narrowband UV-B Phototherapy: Results From 10 Patients and a Review of the Literature

El liquen plano en su forma generalizada (LPG) es en ocasiones difícil de tratar. Cuando fallan los tratamientos tópicos y sistémicos más utilizados como corticoides y antihistamínicos orales la fototerapia se plantea como alternativa. En el momento actual y dadas sus ventajas se utiliza con más frecuencia el ultravioleta B de banda estrecha (UVB-BE). En este trabajo presentamos los resultados en 10 pacientes con LPG tratados con UVB-BE. Para ello realizamos un estudio prospectivo en el que se incluyeron pacientes adultos afectados de LPG en más del 20% de su superficie corporal. Se obtuvo respuesta completa en 8 de los pacientes (80%) con una tasa de recidiva del 25% (2/8). Estos resultados son similares a la literatura revisada. La fototerapia con UVB-BE es ampliamente utilizada como alternativa a los tratamientos sistémicos en el LPG, sin embargo, existen pocos estudios publicados en la literatura sobre sus resultados

Generalized lichen planus can be difficult to treat. One alternative for patients who do not respond to common topical and systemic treatments, such as corticosteroids and oral antihistamines, is phototherapy. Narrowband UV-B phototherapy offers several advantages and is currently the main treatment modality. In this study, we present the results corresponding to 10 patients with generalized lichen planus treated with narrowband UV-B phototherapy. We performed a prospective study of adult patients with generalized lichen planus affecting more than 20% of their body surface area. A complete response was observed in 8 patients (80%) and the disease recurred in 2 of these (recurrence rate, 25%). These rates are similar to those reported in the literature reviewed. Narrowband UV-B phototherapy is a widely used alternative to systemic treatments in GLP, but there are very few reports of its results in the literatura

Generalized Licen Planus Treated With Narrowband UV-B Phototherapy: Results From 10 Patients and a Review of the Literature. / Liquen plano generalizado tratado con ultravioleta B de banda estrecha: resultados en 10 pacientes y revisión de la literatura.

Generalized lichen planus can be difficult to treat. One alternative for patients who do not respond to common topical and systemic treatments, such as corticosteroids and oral antihistamines, is phototherapy. Narrowband UV-B phototherapy offers several advantages and is currently the main treatment modality. In this study, we present the results corresponding to 10 patients with generalized lichen planus treated with narrowband UV-B phototherapy. We performed a prospective study of adult patients with generalized lichen planus affecting more than 20% of their body surface area. A complete response was observed in 8 patients (80%) and the disease recurred in 2 of these (recurrence rate, 25%). These rates are similar to those reported in the literature reviewed. Narrowband UV-B phototherapy is a widely used alternative to systemic treatments in GLP, but there are very few reports of its results in the literature.

Descripción de pacientes no aptos para ser sometidos a cirugía de Mohs tras valoración prequirúrgica: datos del registro español Regesmohs / Description of patients excluded for Mohs surgery after pre-surgical evaluation: data from the Regesmohs Spanish registry

ANTECEDENTES: El registro Regesmohs es un registro de ámbito nacional, de pacientes evaluados y sometidos a una cirugía de Mohs, en 17 centros españoles, desde julio de 2013. Como la cirugía de Mohs es el tratamiento que mejores resultados da para el manejo del carcinoma de células basales (CCB) de alto riesgo y otros tumores de la piel, queríamos describir los motivos por los que algunos pacientes fueron considerados no aptos para ser sometidos a este tratamiento y qué tratamientos alternativos recibieron. Estos datos pueden ser útiles para evitar excluir a pacientes aptos para ser sometidos a una cirugía de Mohs, para calcular la demanda que estos pacientes generan a nivel sanitario, así como la demanda que hay de tratamientos de inhibidores de la vía de Hedgehog en dicho grupo de pacientes. OBJETIVO: Describir a aquellos pacientes que fueron considerados no aptos para ser sometidos a una cirugía de Mohs tras valoración prequirúrgica y los tratamientos que recibieron. MÉTODOS: Regesmohs incluye a todos los pacientes consecutivos para ser sometidos a una cirugía de Mohs en los centros participantes, recogiendo datos sobre las características de los pacientes, las intervenciones y los resultados a corto y largo plazo. Se hizo una descripción de los pacientes considerados no aptos para ser sometidos a una cirugía de Mohs tras valoración prequirúrgica. RESULTADOS: Tres mil once pacientes fueron incluidos en el registro Regesmohs entre julio de 2013 y octubre de 2016. En 85 pacientes no se realizó cirugía de Mohs porque se consideraron candidatos inadecuados. Sesenta y siete pacientes presentaban CCB. Las razones para ser considerado paciente no apto fueron: contraindicaciones médicas (27,1%, n = 23), tumores de bajo riesgo (18,8%, n = 16) y tumores gigantes e invasión ósea (15,3%, n = 13). Solo un paciente (1,2%) reveló compromiso de ganglios linfáticos y ningún paciente metástasis visceral. De los 85 pacientes considerados no aptos 29 (34,1%) fueron sometidos a cirugía convencional, 24 (28,3%) a radioterapia, 4 (4,7%) a inhibidores de la vía de Hedgehog (solo indicado para el CCB) y 2 (2,4%) a tratamiento paliativo. No hubo datos de seguimiento de 14 pacientes (16,5%). CONCLUSIÓN: Las comorbilidades médicas fueron la razón más habitual para retener la cirugía de Mohs. Retener un tratamiento en función de una propagación a lugares distantes no es algo habitual. La mayoría de los pacientes considerados no aptos recibieron tratamientos más sencillos: cirugía convencional o radioterapia, siendo los inhibidores de la vía de Hedgehog una opción novedosa

BACKGROUND: Regesmohs registry is a nationwide registry including patients evaluated for Mohs surgery in 17 Spanish centres since July 2013. Given that Mohs surgery is the therapy with best results for high risk basal cell carcinoma (BCC) and other skin tumours, we wanted to describe the reasons that lead to some patients being excluded from this therapy and the alternative treatments that they received. These data may be useful to avoid excluding patients for Mohs surgery use, to estimate the healthcare demand of these patients and the demand for Hedgehog inhibitors therapy in this group. OBJECTIVE: To describe patients excluded for Mohs surgery after pre-surgical assessment, and the treatments that they received. METHODS: Regesmohs includes all consecutive patients assessed for Mohs surgery in the participating centres, collecting data on patient characteristics, intervention, and short and long-term results. Patients excluded for Mohs surgery after pre-surgical evaluation were described. RESULTS: 3011 patients were included in Regesmohs from July 2013 to October 2016. In 85, Mohs surgery was not performed as they were considered inadequate candidates. 67 had BCC. Reasons for exclusion were: medical contraindication (27.1%, n = 23) low-risk tumour in (18.8%, n = 16) and giant tumour and bone invasion (15.3%, n = 13). Only 1 patient (1.2%) showed lymph node involvement and no patients had visceral metastases. Of the 85 excluded patients, 29 (34.1%) were treated with conventional surgery, 24 (28.3%) with radiotherapy, 4 (4.7%) with inhibitors of the Hedgehog pathway (only indicated for BCC), and 2 (2.4%) received palliative care. We had no follow-up data on 14 patients (16.5%). CONCLUSION: Medical comorbidities were the most common reason for withholding Mohs surgery. Withholding therapy on the basis of distant extension is uncommon. Most excluded patients received simpler therapies: conventional surgery or radiotherapy, with hedgehog inhibitors being a new option

Description of patients excluded for Mohs surgery after pre-surgical evaluation: data from the Regesmohs Spanish registry. / Descripción de pacientes no aptos para ser sometidos a cirugía de Mohs tras valoración prequirúrgica: datos del registro español Regesmohs.

BACKGROUND: Regesmohs registry is a nationwide registry including patients evaluated for Mohs surgery in 17 Spanish centres since July 2013. Given that Mohs surgery is the therapy with best results for high risk basal cell carcinoma (BCC) and other skin tumours, we wanted to describe the reasons that lead to some patients being excluded from this therapy and the alternative treatments that they received. These data may be useful to avoid excluding patients for Mohs surgery use, to estimate the healthcare demand of these patients and the demand for Hedgehog inhibitors therapy in this group. OBJECTIVE: To describe patients excluded for Mohs surgery after pre-surgical assessment, and the treatments that they received. METHODS: Regesmohs includes all consecutive patients assessed for Mohs surgery in the participating centres, collecting data on patient characteristics, intervention, and short and long-term results. Patients excluded for Mohs surgery after pre-surgical evaluation were described. RESULTS: 3011 patients were included in Regesmohs from July 2013 to October 2016. In 85, Mohs surgery was not performed as they were considered inadequate candidates. 67 had BCC. Reasons for exclusion were: medical contraindication (27.1%, n=23) low-risk tumour in (18.8%, n=16) and giant tumour and bone invasion (15.3%, n=13). Only 1 patient (1.2%) showed lymph node involvement and no patients had visceral metastases. Of the 85 excluded patients, 29 (34.1%) were treated with conventional surgery, 24 (28.3%) with radiotherapy, 4 (4.7%) with inhibitors of the Hedgehog pathway (only indicated for BCC), and 2 (2.4%) received palliative care. We had no follow-up data on 14 patients (16.5%). CONCLUSION: Medical comorbidities were the most common reason for withholding Mohs surgery. Withholding therapy on the basis of distant extension is uncommon. Most excluded patients received simpler therapies: conventional surgery or radiotherapy, with hedgehog inhibitors being a new option.

Plan estratégico de la Academia Española de Dermatología y Venereología (AEDV). FuturAEDV 2013-2017 / Strategic Plan for the Spanish Academy of Dermatology and Venerology (AEDV): FuturAEDV 2013-2017

ANTECEDENTES: La Academia Española de Dermatología y Venereología (AEDV) ha planteado la necesidad de definir un plan estratégico para adaptarse y anticiparse al nuevo escenario. OBJETIVOS: 1) Posicionar a la AEDV como una sociedad con capacidad de influencia en todo lo relacionado con la dermatología; 2) contribuir al desarrollo de la especialidad reforzando el prestigio de la misma y de sus profesionales; y 3) introducir en el seno de la Academia un modelo de funcionamiento y de pensamiento estratégico que permita anticiparse a los retos del futuro y que se transmita a las sucesivas juntas directivas. MÉTODOS: Análisis de las tendencias del sistema sanitario, diagnóstico de la situación actual de la AEDV y de la dermatología mediante un análisis interno a través de encuestas y entrevistas a los académicos, análisis de los puntos fuertes y débiles, así como las amenazas y oportunidades, declaración de la misión, y finalmente, la identificación, el desarrollo y la realización de un mapa estratégico con la priorización de las líneas de acción estratégicas. RESULTADOS: Se definió un mapa estratégico con 16 objetivos generales agrupados en 4 ejes (alcanzar la visión, clientes internos y externos, procesos internos e innovación), encuadrados en un plan de acción con 19 iniciativas y acciones concretas para cada una de ellas. La monitorización de su desarrollo la realizará el comité de seguimiento del plan estratégico, formado por la junta permanente y los responsables de los 9 comités técnicos encargados de llevar a cabo cada una de las iniciativas. Comentario: El plan funcional debe guiar la gestión de la AEDV hasta 2017 y su implantación le permitirá posicionarse como referente en cuanto a su modelo funcional y contribuir al desarrollo y prestigio de la especialidad

BACKGROUND: The Spanish Academy of Dermatology and Venereology (AEDV) has decided that a Strategic Plan is needed to help the association adapt to new circumstances and anticipate future developments. OBJECTIVES: 1) To position the AEDV as a medical association that can exert an influence in everything related to dermatology. 2) To contribute to the development of the specialty, strengthening the prestige and reputation of dermatology and dermatologists. 3) To establish a model for operating and strategic thinking that can be handed on to successive Boards of Directors and will enable the Academy to identify future challenges. METHODS: The approach used to develop the Strategic Plan was as follows: analysis of trends in the health care system; assessment of the current situation of AEDV and of dermatology in general through an internal analysis based on surveys and interviews with academics; analysis of strengths, weaknesses, opportunities, and threats; preparation of a mission statement; and identification, development, and implementation of a strategy map prioritizing strategic lines of action. RESULTS: The strategy map set out 16 general goals grouped into 4 main topics (achieving the vision, internal and external customers, internal processes, and innovation) and detailed in an action plan with 19 initiatives, each with specific actions. The plan will be monitored by the Strategic Plan Monitoring Committee, which is made up of the members of the Standing Committee and the chairs of the 9 Technical Committees responsible for implementing the initiatives. Comment: The Functional Plan should guide the management of AEDV until 2017, and its implementation will enable the association to contribute to the development and prestige of the specialty and position itself as a reference in terms of its functional model

Hallazgos dermoscópicos para la detección precoz del melanoma. Análisis de 200 casos / Dermoscopic Findings for the Early Detection of Melanoma: An Analysis of 200 Cases

INTRODUCCIÓN: La dermatoscopia es una técnica complementaria que ha supuesto un gran avance en el diagnóstico de las lesiones pigmentadas. El objetivo del presente trabajo es describir las características dermatoscópicas de una serie de melanomas y analizar las diferencias entre los melanomas in situ y los melanomas invasivos. MATERIAL Y MÉTODOS: Se obtuvieron de forma retrospectiva los datos referentes a las características epidemiológicas, clínicas, histológicas y dermoscópicas de una serie de 200 melanomas primarios. Se realizó un estudio descriptivo y analítico de las variables dermoscópicas. RESULTADOS: La edad media de los pacientes fue de 63 años, con una distribución similar por sexos. Los tipos histológicos más frecuentes fueron el melanoma de extensión superficial (62,5%) y el lentigo maligno (25,5%). El 67% de los melanomas tuvieron un índice de Breslow menor de 1 mm y un 24,5% fueron melanomas in situ. Los patrones dermatoscópicos globales más frecuentes fueron el multicomponente (33,5%), el reticular (18%) y el inespecífico (15,5%). Las estructuras dermatoscópicas más frecuentes fueron las áreas homogéneas desestructuradas (67,5%), las estructuras blanco-azuladas (58%), el retículo pigmentado atípico (55,5%) y los puntos y glóbulos de distribución irregular (44%). Los colores azul-gris, rojo y blanco, los patrones multicomponente y homogéneo, los puntos y glóbulos, las estructuras blanco-azuladas, las áreas homogéneas, el velo azul-blanquecino, las estructuras blancas brillantes, el retículo invertido y las áreas rojo lechosas fueron más frecuentes en los melanomas invasivos que en los melanomas in situ. El patrón reticular fue más frecuente en los melanomas in situ. DISCUSIÓN: El uso de la dermatoscopia ha contribuido al diagnóstico precoz del melanoma. Los datos dermatoscópicos más frecuentes en el melanoma son la presencia de múltiples estructuras y colores (patrón multicomponente), un patrón reticular atípico con una red ensanchada e irregular y la ausencia de criterios dermatoscópicos (patrón inespecífico) asociada a la presencia de estructuras vasculares. CONCLUSIONES: La dermatoscopia facilita el diagnóstico de melanoma. Podría tener utilidad para diferenciar los melanomas in situ de las formas invasivas

INTRODUCTION: Dermoscopy is a complementary technique that has led to major advances in the diagnosis of pigmented skin lesions. The aim of this study was to describe the dermoscopic features of a series of melanomas and analyze the differences between melanomas in situ and invasive melanomas. MATERIAL AND METHODS: We retrospectively recorded epidemiological, clinical, histologic, and dermoscopic features of a series of 200 primary melanomas. We performed a descriptive and analytical study of the dermoscopic features identified. RESULTS: The mean age of the patients was 63 years and there was a similar distribution of male and female patients. The most common histologic subtypes were superficial spreading melanoma (62.5%) and lentigo maligna (25.5%); 67% of the melanomas had a Breslow thickness of less than 1 mm and 24.5% were melanomas in situ. Overall,the most common global dermoscopic features were the multicomponent pattern (33.5%), the reticular pattern (18%), and the nonspecific pattern (15.5%). The most common local features were structureless homogeneous areas (67.5%), white-blue structures (58%), an atypical pigmented network (55.5%), and irregularly distributed dots and globules (44%). The following features were more common in invasive melanomas than in melanomas in situ: blue, gray, red and white colors, multicomponent and homogeneous patterns, dots and globules, blue-white structures, homogeneous areas, a blue-white veil, white shiny structures, a reverse pigment network, and milky-red areas. The reticular pattern was more common in melanomas in situ. DISCUSSION: The use of dermoscopy has contributed to the early diagnosis of melanoma. The most common dermoscopic features of melanoma are multiple structures and colors (multicomponent pattern), an atypical reticular pattern (with wide, irregular meshes), and an absence of distinguishing features (nonspecific pattern) associated with the presence of vascular structures. CONCLUSIONS: Dermoscopy facilitates the diagnosis of melanoma and could be useful for differentiating between melanoma in situ and invasive melanoma

Strategic Plan for the Spanish Academy of Dermatology and Venerology (AEDV): FuturAEDV 2013-2017.

BACKGROUND: The Spanish Academy of Dermatology and Venereology (AEDV) has decided that a Strategic Plan is needed to help the association adapt to new circumstances and anticipate future developments. OBJECTIVES: 1) To position the AEDV as a medical association that can exert an influence in everything related to dermatology. 2) To contribute to the development of the specialty, strengthening the prestige and reputation of dermatology and dermatologists. 3) To establish a model for operating and strategic thinking that can be handed on to successive Boards of Directors and will enable the Academy to identify future challenges. METHODS: The approach used to develop the Strategic Plan was as follows: analysis of trends in the health care system; assessment of the current situation of AEDV and of dermatology in general through an internal analysis based on surveys and interviews with academics; analysis of strengths, weaknesses, opportunities, and threats; preparation of a mission statement; and identification, development, and implementation of a strategy map prioritizing strategic lines of action. RESULTS: The strategy map set out 16 general goals grouped into 4 main topics (achieving the vision, internal and external customers, internal processes, and innovation) and detailed in an action plan with 19 initiatives, each with specific actions. The plan will be monitored by the Strategic Plan Monitoring Committee, which is made up of the members of the Standing Committee and the chairs of the 9 Technical Committees responsible for implementing the initiatives. COMMENT: The Functional Plan should guide the management of AEDV until 2017, and its implementation will enable the association to contribute to the development and prestige of the specialty and position itself as a reference in terms of its functional model.

Dermoscopic findings for the early detection of melanoma: an analysis of 200 cases.

INTRODUCTION: Dermoscopy is a complementary technique that has led to major advances in the diagnosis of pigmented skin lesions. The aim of this study was to describe the dermoscopic features of a series of melanomas and analyze the differences between melanomas in situ and invasive melanomas. MATERIAL AND METHODS: We retrospectively recorded epidemiological, clinical, histologic, and dermoscopic features of a series of 200 primary melanomas. We performed a descriptive and analytical study of the dermoscopic features identified. RESULTS: The mean age of the patients was 63 years and there was a similar distribution of male and female patients. The most common histologic subtypes were superficial spreading melanoma (62.5%) and lentigo maligna (25.5%); 67% of the melanomas had a Breslow thickness of less than 1mm and 24.5% were melanomas in situ. Overall,the most common global dermoscopic features were the multicomponent pattern (33.5%), the reticular pattern (18%), and the nonspecific pattern (15.5%). The most common local features were structureless homogeneous areas (67.5%), white-blue structures (58%), an atypical pigmented network (55.5%), and irregularly distributed dots and globules (44%). The following features were more common in invasive melanomas than in melanomas in situ: blue, gray, red and white colors, multicomponent and homogeneous patterns, dots and globules, blue-white structures, homogeneous areas, a blue-white veil, white shiny structures, a reverse pigment network, and milky-red areas. The reticular pattern was more common in melanomas in situ. DISCUSSION: The use of dermoscopy has contributed to the early diagnosis of melanoma. The most common dermoscopic features of melanoma are multiple structures and colors (multicomponent pattern), an atypical reticular pattern (with wide, irregular meshes), and an absence of distinguishing features (nonspecific pattern) associated with the presence of vascular structures. CONCLUSIONS: Dermoscopy facilitates the diagnosis of melanoma and could be useful for differentiating between melanoma in situ and invasive melanoma.

Melanoma de tipo animal: características clínicas y dermatoscópicas de 3 casos / Animal-type Melanoma: Clinical and Dermoscopic Features of 3 Cases

El melanoma de tipo animal es una variante infrecuente de melanoma maligno humano. A pesar de desarrollar metástasis locorregionales y a distancia, con frecuencia estos pacientes presentan una tasa de mortalidad inferior a la de otros tipos de melanoma. Presentamos 3 casos de melanoma de tipo animal en 3 varones de edad avanzada, con características clínicas y dermatoscópicas comunes (patrón azul homogéneo, estructuras blanquecinas irregulares y vasos gruesos irregulares)

Animal-type melanoma is a rare variant of malignant melanoma in humans. Although many patients develop locoregional and distant metastases, mortality is lower than in other types of melanoma. We present 3 cases of animal-type melanoma in elderly men and include a description of common clinical and dermoscopic features (homogeneous blue pattern, irregular whitish structures, and irregular large vessels)

Características epidemiológicas de los pacientes con lupus eritematoso cutáneo / Epidemiological Characteristics of Patients With Cutaneous Lupus Erythematosus

INTRODUCCIÓN Y OBJETIVOS: El lupus eritematoso es una enfermedad inflamatoria crónica autoinmune con un amplio espectro clínico y evolutivo. Existen pocos estudios sobre las características de los enfermos de lupus eritematoso exclusivamente cutáneo. El presente estudio pretende describir las características epidemiológicas, clínicas e inmunológicas de una serie de pacientes diagnosticados de lupus eritematoso cutáneo. Pacientes y método: Se analizaron los datos referentes a todos los pacientes mayores de edad diagnosticados de lupus eritematoso cutáneo que fueron atendidos por este motivo entre el 1 de enero de 2007 y el 31 de diciembre de 2011 en un hospital de tercer nivel. RESULTADOS Y CONCLUSIONES: Un total de 101 pacientes fueron incluidos en el estudio. La edad media al diagnóstico fue de 40 años. El 84% fueron mujeres, representando el 94% en las formas subagudas. El 79% de las formas crónicas discoides se localizaron exclusivamente en la cabeza y el cuello, mientras que el 97% de las formas subagudas se localizaron en el tronco. Las formas agudas presentaron positividad en los títulos de ANA, anti-ADN, anti-Sm y anti-RNP. Los anticuerpos anti-Ro y anti-La predominaron en las formas subagudas. Diecisiete pacientes presentaron más de un subtipo de lupus eritematoso cutáneo; 15 de estos 17 (88%) pacientes recibieron tratamiento con inmunosupresores frente a 44 de 84 (52%) de los que presentaron un solo subtipo de lupus eritematoso cutáneo. Los pacientes pertenecientes a los distintos subtipos de lupus eritematoso cutáneo presentan unas características clínicas e inmunológicas diferenciadoras. Existe una importante proporción de pacientes con distintos subtipos de lupus eritematoso cutáneo que suelen necesitar tratamientos con inmunosupresores orales para el control de su enfermedad

INTRODUCTION AND OBJECTIVES: Lupus erythematosus is a chronic autoimmune inflammatory disease with a wide clinical spectrum and variable clinical course. Few studies have analyzed the characteristics of patients with only cutaneous lupus erythematosus (CLE). The aim of this study was to describe the epidemiological, clinical, and immunological characteristics of a series of patients diagnosed with CLE. PATIENTS AND METHODS: An analysis was performed of the data from all patients over 18 years of age with a diagnosis of CLE and seen between January 1, 2007 and December 31, 2011 in a tertiary hospital. RESULTS AND CONCLUSIONS: One hundred one patients were included in the study. The mean age at diagnosis was 40 years and 84% were women. Subacute forms of presentation were observed in 94% of patients. The chronic discoid forms were localized to the head and neck in 79% of cases, whereas the subacute forms were on the trunk in 97% of cases. Patients with acute forms were positive for antinuclear, anti-DNA, anti-smooth muscle, and anti-RNP (ribonucleoprotein) antibodies, whereas anti-Ro and anti-La antibodies predominated in patients with subacute forms. Seventeen patients presented more than 1 subtype of CLE. Fifteen (88%) of these patients received immunosuppressor treatment versus 44 (52%) of the other 84 patients with only 1 subtype of CLE. Patients with distinct subtypes of CLE present different clinical and immunological characteristics. Oral immunosuppressants are often needed to control the disease in a large proportion of patients with different subtypes of CLE

Epidemiological characteristics of patients with cutaneous lupus erythematosus.

INTRODUCTION AND OBJECTIVES: Lupus erythematosus is a chronic autoimmune inflammatory disease with a wide clinical spectrum and variable clinical course. Few studies have analyzed the characteristics of patients with only cutaneous lupus erythematosus (CLE). The aim of this study was to describe the epidemiological, clinical, and immunological characteristics of a series of patients diagnosed with CLE. PATIENTS AND METHODS: An analysis was performed of the data from all patients over 18 years of age with a diagnosis of CLE and seen between January 1, 2007 and December 31, 2011 in a tertiary hospital. RESULTS AND CONCLUSIONS: One hundred- one patients were included in the study. The mean age at diagnosis was 40 years and 84% were women. Subacute forms of presentation were observed in 94% of patients. The chronic discoid forms were localized to the head and neck in 79% of cases, whereas the subacute forms were on the trunk in 97% of cases. Patients with acute forms were positive for antinuclear, anti-DNA, anti-smooth muscle, and anti-RNP (ribonucleoprotein) antibodies, whereas anti-Ro and anti-La antibodies predominated in patients with subacute forms. Seventeen patients presented more than 1 subtype of CLE. Fifteen (88%) of these patients received immunosuppressor treatment versus 44 (52%) of the other 84 patients with only 1 subtype of CLE. Patients with distinct subtypes of CLE present different clinical and immunological characteristics. Oral immunosuppressants are often needed to control the disease in a large proportion of patients with different subtypes of CLE.

Animal-type melanoma: clinical and dermoscopic features of 3 cases.

Animal-type melanoma is a rare variant of malignant melanoma in humans. Although many patients develop locoregional and distant metastases, mortality is lower than in other types of melanoma. We present 3 cases of animal-type melanoma in elderly men and include a description of common clinical and dermoscopic features (homogeneous blue pattern, irregular whitish structures, and irregular large vessels).

Cambios epidemiológicos en el melanoma cutáneo: estudio retrospectivo de 969 casos (1996-2010) / Epidemiological changes in cutaneous melanoma: retrospective study of 969 cases (1996-2010)

Introducción. La incidencia del melanoma cutáneo ha aumentando durante las últimas décadas en muchos países, pero desconocemos si esto también ha sucedido en Madrid. Hemos analizado los cambios epidemiológicos ocurridos en el melanoma cutáneo durante un período de 15 años. Pacientes y métodos. Se obtuvieron de forma retrospectiva los datos referentes a todos los pacientes con melanoma cutáneo atendidos en el Hospital Gregorio Marañón de Madrid entre los años 1996-2010, dividido en 3 periodos: 1996-2000; 2001-2005, y 2006-2010. Resultados. Se diagnosticaron histológicamente un total de 969 melanomas. La edad media en el momento del diagnóstico fue de 58,5 años. El espesor tumoral medio fue de 1,61mm. El tipo histológico más frecuente fue el melanoma de extensión superficial. Las diferencias estadísticamente significativas (p<0,05) entre los 3 periodos del estudio fueron: mayor edad media al diagnóstico (p<0,001); mayor número de melanomas en cabeza y cuello (p<0,001); mayor número de melanomas en tronco en el sexo femenino (p<0,001); aumento del melanoma tipo lentigo maligno (p<0,001); disminución del espesor medio (índice de Breslow) (p<0,001); mayor número de melanomas intraepidérmicos (p<0,001). Sin embargo, la proporción de melanomas gruesos (>2mm de Breslow) se mantuvo por encima del 20%, siendo más frecuente este subtipo de melanomas en varones y en mayores de 65 años. Conclusiones. El melanoma cutáneo en España se diagnostica con un espesor tumoral medio cada vez más fino, aunque se siguen diagnosticando melanomas de gran espesor especialmente en varones y pacientes de más de 65 años(AU)

Background. The incidence of malignant melanoma has increased over recent decades all over the world; however, we are not aware if this also occurs in Madrid. Our objective was to analyze epidemiological changes in cutaneous malignant melanomas diagnosed over a 15-year period. Patients and methods. Retrospective analysis of data of patients with primary cutaneous melanomas attended at Hospital Gregorio Marañón, Madrid, Spain, between 1996 and 2010, divided into three periods: 1996-2000; 2001-2005; 2006-2010, were obtained. Results. In total, 969 melanomas were histologically diagnosed. The mean age at the moment of diagnosis was 58.5 years old. The mean tumor thickness was 1.61mm. The most common histological type was surface-spreading melanoma and the most common site was the trunk. There were statistically significant differences (P<.05) between the three periods of the study: Older age at diagnoses (P<.001); larger number of head and neck melanomas (P<.001); more melanomas on trunk in women (P<.001); increase of lentigo maligna melanoma (P<.001); thinner mean tumor thickness (Breslow index) (P<.001); larger number of melanomas in situ (P<.001). However, thick melanomas (tumor thickness over 2mm) ratio was still over 20% in all periods, especially in males and in those over 65 years old. Conclusions. Diagnosis of cutaneous melanoma in Spain is made increasingly with a thinner mean tumor thickness, although thick melanomas are still diagnosed in men and in individuals over 65 years(AU)

Epidemiological changes in cutaneous melanoma: retrospective study of 969 cases (1996-2010).

BACKGROUND: The incidence of malignant melanoma has increased over recent decades all over the world; however, we are not aware if this also occurs in Madrid. Our objective was to analyze epidemiological changes in cutaneous malignant melanomas diagnosed over a 15-year period. PATIENTS AND METHODS: Retrospective analysis of data of patients with primary cutaneous melanomas attended at Hospital Gregorio Marañón, Madrid, Spain, between 1996 and 2010, divided into three periods: 1996-2000; 2001-2005; 2006-2010, was obtained. RESULTS: In total, 969 melanomas were histologically diagnosed. The mean age at the moment of diagnosis was 58.5 years old. The mean tumor thickness was 1.61 mm. The most common histological type was surface-spreading melanoma and the most common site was the trunk. There were statistically significant differences (P < .05) between the three periods of the study: older age at diagnoses (P < .001); larger number of head and neck melanomas (P < .001); more melanomas on trunk in women (P < .001); increase of lentigo maligna melanoma (P < .001); thinner mean tumor thickness (Breslow index) (P < .001); larger number of melanomas in situ (P < .001). However, thick melanomas (tumor thickness over 2 mm) ratio was still over 20% in all periods, especially in males and in those over 65 years old. CONCLUSIONS: Diagnosis of cutaneous melanoma in Spain is made increasingly with a thinner mean tumor thickness, although thick melanomas are still diagnosed in men and in individuals over 65 years.

Dermatosis inflamatorias vulvares / Vulvar Inflammatory Dermatoses

La patología cutánea vulvar constituye un motivo frecuente de consulta en el momento actual. La vulva, al igual que el resto de la piel, puede verse afectada por múltiples enfermedades de diferentes etiologías, pero sus especiales condiciones anatómicas y fisiológicas hacen que tenga algunas peculiaridades que pueden suponer una dificultad añadida en su manejo. El estudio de la patología vulvar está emergiendo como una nueva área en la Dermatología. En este artículo, tras valorar la características de la vulva normal, sistematizaremos y realizaremos una breve revisión de las dermatosis inflamatorias vulvares, grupo heterogéneo de enfermedades en las que es clave un abordaje amplio y multidisciplinar (AU)

Vulvar skin disease is a common reason for consultation. The vulva, like the rest of the skin, can be affected by numerous diseases of various etiologies, but its particular anatomic and physiologic characteristics create additional diagnostic and therapeutic difficulties. The study of vulvar disease is emerging as a new branch of dermatology. In this article, we examine the characteristics of the normal vulva, and perform a brief, structured review of vulvar inflammatory dermatoses, which comprise a heterogeneous group of diseases in which a broad, multidisciplinary approach is essential (AU)

Histological ulceration as a prognostic factor in cutaneous melanoma: a study of 423 cases in Spain

INTRODUCTION: Histological ulceration in cutaneous melanoma carries a high risk of metastasis and has a poor prognosis. However, some epidemiological and survival studies of patients with cutaneous melanoma do not consider histological ulceration as one of the main prognostic factors. MATERIALS AND METHODS: Epidemiological, clinical, histological and survival characteristics of all patients diagnosed with cutaneous melanoma over a 10-year period (1994- 2003) were retrospectively analysed. RESULTS: Ulcerated melanoma was observed in 77 of 423 patients (18.2%). Ulceration was significantly associated with male sex, deeper tumour thickness, positive sentinel lymph node biopsy and metastasis (p<0.001). Histological ulceration indicates a high relative risk (RR) of death from melanoma (RR 9.41; 95% CI 4.52-19.59) and a significant risk of metastasis (RR 5.72; 95% CI 3.56-9.19) (p<0.001). CONCLUSIONS: Histological ulceration is associated with lower overall survival and disease-free survival in patients with cutaneous melanoma. Presence of ulceration must be included in the clinical history of patients with melanoma to ensure a careful diagnostic work-up and follow-up (AU)

[Vulvar inflammatory dermatoses]. / Dermatosis inflamatorias vulvares.

Vulvar skin disease is a common reason for consultation. The vulva, like the rest of the skin, can be affected by numerous diseases of various etiologies, but its particular anatomic and physiologic characteristics create additional diagnostic and therapeutic difficulties. The study of vulvar disease is emerging as a new branch of dermatology. In this article, we examine the characteristics of the normal vulva, and perform a brief, structured review of vulvar inflammatory dermatoses, which comprise a heterogeneous group of diseases in which a broad, multidisciplinary approach is essential.

Dermatomiositis: estudio y seguimiento de 20 pacientes / Dermatomyositis: Assessment and Follow-up of 20 Patients

Introducción: la dermatomiositis (DM) se engloba dentro de las miopatías inflamatorias idiopáticas. La piel y el músculo esquelético son los órganos principalmente afectados. Un porcentaje significativo de pacientes, estimado entre un 15-25%, presentan un proceso neoplásico subyacente, aunque existen también formas exclusivamente cutáneas. Aún no se han identificado con exactitud qué factores predicen la evolución y el pronóstico de estos pacientes. En este trabajo aportamos muestra experiencia a partir de la descripción y análisis de una serie de pacientes. Material y métodos: estudio retrospectivo de 20 pacientes con diagnóstico de DM en seguimiento en el Servicio de Dermatología del Hospital General Universitario Gregorio Marañón, durante el periodo comprendido entre febrero de 2007 y febrero de 2010. Se evaluaron las características clínicas, histopatológicas, analíticas, pruebas complementarias y tratamientos realizados en dichos pacientes. Resultados: del total de la serie de pacientes 19 fueron mujeres. La edad media fue de 61 años (mediana 60). Identificamos 11 DM clásicas, 3 DM amiopáticas, 2 DM paraneoplásicas, 2 DM asociadas a enfermedad del tejido conectivo, una DM por fármacos y una DM juvenil. El eritema en heliotropo, las pápulas de Gottron y el eritema periungueal fueron las lesiones cutáneas más frecuentes. La necrosis cutánea estuvo presente en las dos pacientes con DM paraneoplásica. Los anticuerpos específicos de miositis fueron negativos en todos los pacientes. El tratamiento inicial fueron los corticoides sistémicos en el 85%. El 80% precisó la asociación de dos o más fármacos para el control de la enfermedad. Conclusiones: La DM es un proceso potencialmente grave. El dermatólogo puede facilitar el diagnóstico y contribuir a detectar neoplasias asociadas y complicaciones sistémicas precozmente. La mayoría de los pacientes presentan un buen pronóstico, aunque requieren periodos de tratamiento prolongados. Los casos con más complicaciones son aquellos asociados a neoplasias y cuando existe compromiso cardiopulmonar (AU)

Background: Dermatomyositis is an idiopathic inflammatory myopathy that mainly affects the skin and skeletal muscle. An estimated 15% to 25% of patients have underlying tumors and some forms are exclusively cutaneous. The factors that predict disease course and prognosis in these patients have not been clearly identified. Here we report our experience through the description and analysis of a series of patients. Material and methods: This was a retrospective study of 20 patients with a diagnosis of dermatomyositis undergoing follow-up in the Department of Dermatology at Hospital General Universitario Gregorio Marañón in Madrid, Spain between February 2007 and February 2010. Clinical and histopathological characteristics were assessed alongside the results of laboratory tests and the treatments used. Results: Nineteen of the 20 patients included in the study were women. The mean age was 61years (median, 60 years). We identified 11 patients with classic, 3 with amyopathic, 2 with paraneoplastic, 1 with drug-associated, and 1 with juvenile dermatomyositis, and 2 patients had dermatomyositis associated with connective tissue disease. Heliotrope erythema, Gottron papules, and periungual erythema were the most frequent skin lesions. Cutaneous necrosis was present in 2 patients with paraneoplastic dermatomyositis. None of the patients had myositis-specific antibodies. Initial treatment was with systemic corticosteroids in 85% of cases. Eighty percent of patients required 2 or more drugs to achieve disease control. Conclusions: Dermatomyositis is a potentially serious disease. Dermatologists can facilitate diagnosis and contribute to the early detection of associated tumors and systemic complications. In most patients, the disease has a good prognosis, although extended periods of treatment may be required. Complications occur most commonly in patients with associated tumors or cardiopulmonary disease (AU)