[[Translated article]Melanoma Registry of the Spanish Academy of Dermatology and Venereology (REGESMEL): Description and Data in its First Year of Operation. / Registro de Melanoma de la Academia Española de Dermatología y Venereología (REGESMEL): descripción y datos en el primer año de funcionamiento.

INTRODUCTION: The incidence of melanoma is growing in Spain. The prognostic stages of patients with melanoma are determined by various biological factors, such as tumor thickness, ulceration, or the presence of regional or distant metastases. The Spanish Academy of Dermatology and Venereology (AEDV) has encouraged the creation of a Spanish Melanoma Registry (REGESMEL) to evaluate other individual and health system-related factors that may impact the prognosis of patients with melanoma. The aim of this article is to introduce REGESMEL and provide basic descriptive data on to its first year in service. METHODS: REGESMEL is a prospective, multicentre cohort of consecutive patients with invasive cutaneous melanoma that includes demographics, staging, individual, and health care-related baseline data, while storing the patients' health records and surgical treatment received. RESULTS: A total of 450 cases of invasive cutaneous melanoma from 19 participant centres were included, with a predominance of thin melanomas ≤ 1 mm thick (54.7%), mainly located on the posterior trunk (35.2%). Selective sentinel lymph node biopsy was performed in 40.7% of the cases. Most cases of melanoma were suspected by the patient (30.4%), or his/her dermatologist (29.6%). Patients received care mainly in public health centers (85.2%), with tele-dermatology resources being used in 21.6% of the cases. CONCLUSIONS: The distribution of the pathological and demographic variables of melanoma cases is consistent with data from former studies. REGESMEL has already recruited patients from 15 Spanish provinces and given its potential representativeness, it renders the Registry as an important tool to address a wide range of research questions.

Melanoma Registry of the Spanish Academy of Dermatology and Venereology (REGESMEL): Description and Data in its First Year of Operation. / Registro de Melanoma de la Academia Española de Dermatología y Venereología (REGESMEL): descripción y datos en el primer año de funcionamiento.

INTRODUCTION: The incidence of melanoma is rising in Spain. The prognostic stages of patients with melanoma are determined by various biological factors, such as tumor thickness, ulceration, or the presence of regional or distant metastases. The Spanish Academy of Dermatology and Venereology (AEDV) has encouraged the creation of a Spanish Melanoma Registry (REGESMEL) to evaluate other individual and health system-related factors that may impact the prognosis of patients with melanoma. The aim of this article is to introduce REGESMEL and provide basic descriptive data for its first year of operation. METHODS: REGESMEL is a prospective, multicentre cohort of consecutive patients with invasive cutaneous melanoma that collects demographic and staging data as well as individual and healthcare-related baseline data. It also records the medical and surgical treatment received by patients. RESULTS: A total of 450 cases of invasive cutaneous melanoma from 19 participant centres were included, with a predominance of thin melanomas≤1mm thick (54.7%), mainly located on the posterior trunk (35.2%). Selective sentinel lymph node biopsy was performed in 40.7% of cases. Most cases of melanoma were suspected by the patient (30.4%), or his/her dermatologist (29.6%). Patients received care mainly in public health centers (85.2%), with tele-dermatology resources being used in 21.6% of the cases. CONCLUSIONS: The distribution of the pathological and demographic variables of melanoma cases is consistent with data from former studies. REGESMEL has already recruited patients from 15 Spanish provinces and given its potential representativeness, it renders the Registry as an important tool to address a wide range of research questions.

Dermoscopy of cutaneous smooth muscle neoplasms: a morphological study of 136 cases.

BACKGROUND: A variety of cutaneous smooth muscle neoplasms may arise in the skin and are frequently unrecognized by clinicians. There is sparse data relating to the dermoscopy of piloleiomyomas (PL), and nothing has been published about the dermoscopy of angioleiomyomas (AL) and leiomyosarcomas (LS). OBJECTIVES: To evaluate the morphological findings of a large series of cutaneous PL, AL and LS under dermoscopic observation, comparing these findings among them. METHODS: Digital dermoscopic images of 136 histopathologically confirmed cases of cutaneous smooth muscle neoplasms (114 PL, 13 AL and 9 LS) collected from 10 Hospitals in Spain, Austria and Italy were evaluated for the presence of dermoscopic structures and patterns. RESULTS: The pattern composed of a symmetric, total delicate pigment network with the variable presence of multiple hypopigmented areas in a painful lesion is the most common dermoscopic pattern associated with PL. This pattern was found in 69.3% of PL and in no cases of AL and LS. The most common and characteristic pattern associated with AL was the one composed of symmetric pink-reddish tumour with vessels, white structures and the absence of ulceration, which was found in 46.2% of AL, but also in 3.5% of PL, and in 22.2% of LS. Finally, the most common pattern associated with LS was the one composed of an asymmetric, multilobulated tumour with linear-irregular or polymorphic-atypical vessels and white structures, which was found in 44.4% of cases, but also in 0.9% of PL and in 15.4% of AL. CONCLUSION: Dermoscopy is helpful in improving the diagnostic accuracy of PL. The dermoscopic patterns associated with AL and LS were more variable and less specific.

Dermoscopy of inverted follicular keratosis: study of 12 cases.

BACKGROUND: Inverted follicular keratosis (IFK) is an uncommon benign tumour of the follicular infundibulum, which is often misdiagnosed clinically as other keratinizing tumours, and commonly diagnosed correctly by histopathology. There are few reports about the dermoscopic findings of this lesion. AIM: To evaluate the dermoscopic features of IFK. METHODS: The dermoscopic structures and patterns in digital dermoscopic images of 12 histopathologically confirmed cases of IFK collected from 5 hospitals in Spain were evaluated. RESULTS: A keratoacanthoma (KA)-like pattern composed of central keratin surrounded by hairpin vessels in a radial arrangement was the most common pattern in IFK (58.3%). The second most common pattern was composed of a yellowish-white amorphous central area surrounded by vascular structures in a radial arrangement (33.3%). The remaining case showed a pattern composed of a yellowish-white amorphous central area with milky red globules. Vascular structures were present in all cases, with a monomorphic pattern in seven cases and a polymorphic pattern in five, mainly with radial arrangement. Arborizing vessels, linear irregular vessels, corkscrew vessels and milky red globules were present in some cases. CONCLUSIONS: We describe the two main patterns of IFK. Lesions with a KA-like pattern are clinically and dermoscopically undistinguishable from KA and squamous cell carcinoma. Cases with a polymorphic vascular pattern could be confused with malignant tumours, including basal cell carcinoma and amelanotic melanoma.

Dermoscopy of tumours arising in naevus sebaceous: a morphological study of 58 cases.

BACKGROUND: Naevus sebaceous is a congenital hamartoma commonly associated with the development of secondary neoplasms. There are sparse data relating to the dermoscopy of tumours arising in naevus sebaceous. OBJECTIVES: To evaluate the dermoscopic features of a large series of neoplasms arising in naevus sebaceous. METHODS: Digital dermoscopic images of 58 histopathologically confirmed cases of secondary neoplasms arising in naevus sebaceous collected from 11 hospitals in Spain, France, Italy and Austria were evaluated for the presence of dermoscopic structures and patterns. RESULTS: The most frequent tumours collected were: trichoblastoma (39.6%), basal cell carcinoma (20.7%) and syringocystadenoma papilliferum (15.6%). The most remarkable findings were: (i) the pattern composed of asymmetrical large blue-grey ovoid nests was more common in basal cell carcinomas than in trichoblastoma (58.3% vs. 4.3%; P < 0.001) and the pattern composed of a symmetrical total large blue-grey ovoid nest (a blue-grey homogeneous area which occupies the whole lesion) was more common in trichoblastoma (82.6% vs. 16.6%; P < 0.001); (ii) the most frequent pattern associated with syringocystadenoma papilliferum was a symmetric, erythematous lesion with exophytic papillary structures, ulceration and vessels (55.5%); (iii) the most common pattern associated with apocrine hidrocystomas was a total symmetric homogeneous area and arborizing telangiectasias (60%). CONCLUSIONS: Benign adnexal tumours associated with naevus sebaceous are dermoscopic mimickers of basal cell carcinomas. A pigmented nodule arising in a naevus sebaceous with a total blue large ovoid nest on dermoscopy could be a trichoblastoma, basal cell carcinoma, hidrocystoma or hidradenoma. Dermoscopy can be a useful diagnostic tool which generates a more accurate preoperative diagnosis.

Four imported cases of tungiasis in Mallorca.

Tungiasis is an endemic disease in many resource-poor communities some of which are in South America, which are visited frequently by Spanish travelers. Its diagnosis can be improved with the knowledge of the typical presentation and the correct management of its injuries. We report the first four cases identified of imported tungiasis in Mallorca. All four patients visited beaches in Brazil and presented the classical black lesions after their return. Two of the patients were diagnosed at primary care level and all were treated by dermatologists with surgical techniques. Dermoscopy was used for the initial approach to the injuries. Tungiasis can be suspected easily by examining carefully the black lesions and asking about previous travel. It can be treated readily by minor surgical techniques.

Dermoscopy of pyogenic granuloma: a morphological study.

BACKGROUND: Pyogenic granuloma is a common, benign, vascular lesion of the skin and mucous membranes which is a simulator of amelanotic/hypomelanotic melanoma and other tumours. OBJECTIVES: To determine the diagnostic significance of dermoscopic structures and patterns associated with pyogenic granulomas in a large series of cases. METHODS: Digital dermoscopic images of histopathologically proven cases of 122 pyogenic granulomas and 140 other tumours (28 amelanotic melanomas, seven melanoma metastases, 22 basal cell carcinomas and 83 other tumours) were collected from university hospitals in Spain, Italy, Austria and Turkey. The frequency, sensitivity, specificity, positive predictive value, negative predictive value, intraobserver agreement and interobserver agreement of the dermoscopic structures and patterns associated with pyogenic granulomas were calculated. RESULTS: Vascular structures were observed in 45% of pyogenic granulomas (sensitivity of 45·1% and specificity of 17·9%; both P < 0·001). Seven exclusive patterns were made up from the combination of the structures 'reddish homogeneous area' (RHA), 'white collarette' (WC), 'white rail lines' (WRL) and 'vascular structures' (VS). The pattern composed of RHA, WC and WRL showed the highest sensitivity (22·1%; P < 0·001) and a specificity of 100% (P < 0·001) for pyogenic granulomas. Two other patterns (RHA + WC and RHA + WC + WRL + VS) showed 100% specificity when compared with melanoma (P < 0·001 and P < 0·05, respectively). CONCLUSIONS: Even though some dermoscopic patterns are useful in the recognition of pyogenic granulomas, dermoscopy is not a substitute for histology, mostly when vessels are present, as melanoma cannot be ruled out.

[Dermatology service utilization and reasons for consultation by Spanish and immigrant patients in the region served by Hospital Son Llàtzer, Palma de Majorca, Spain]. / Motivos de consulta dermatológicos en la población inmigrante y española del área de salud del Hospital Son Llàtzer (Mallorca).

INTRODUCTION: Spain has come to be one of the main European destinations for immigrants from countries with low per capita incomes. The Balearic Islands have the second largest proportion of immigrants in a Spanish autonomous community. The aim of this study was to describe the dermatology service utilization by immigrant and Spanish populations at Hospital Son Llàtzer in Palma de Majorca, Spain. PATIENTS AND METHODS: A longitudinal, descriptive study was undertaken to analyze first visits to the dermatology department of Hospital Son Llàtzer between July 10, 2007 and July 9, 2008. RESULTS: Of the 6699 first visits, 13. 2% were by non-Spanish patients, originating from 64 different countries, with Argentina, Ecuador, and Columbia the most common. Spanish patients consulted more frequently than non-Spanish patients. Patients from outside the European Union consulted most often for inflammatory conditions, whereas patients from Spain and other countries of the European Union mainly consulted for benign tumors. Consultations were for sexually transmitted disease in 2% of visits. The reason for the visit was classified as cosmetic in 14. 1% of patients. CONCLUSIONS: The dermatology service utilization by the immigrant population was lower than by Spanish patients, although with differences according to the country of origin.

Motivos de consulta dermatológicos en la población inmigrante y española del área de salud del Hospital Son Llàtzer (Mallorca) / Dermatology Service Utilization and Reasons for Consultation by Spanish and Immigrant Patients in the Region Served by Hospital Son Llàtzer, Palma de Majorca, Spain

Introducción: España ha pasado a convertirse en uno de los principales destinos europeos de inmigrantes procedentes de países con rentas per capita más bajas. La Comunidad Autónoma de las Islas Baleares es la segunda con mayor proporción de ciudadanos de origen extranjero. Nuestro trabajo pretende describir la demanda asistencial en la población inmigrante atendida en el Servicio de Dermatología del Hospital Son Llàtzer, en las Islas Baleares, y compararla con la de la población autóctona. Pacientes y métodos: Se trata de un estudio descriptivo longitudinal sobre las primeras visitas atendidas en el Servicio de Dermatología del Hospital Son Llàtzer desde el 10 de julio de 2007 al 9 de julio de 2008. Resultados: Se atendieron 6.699 primeras visitas. Un 13,2% fue de origen extranjero. Se recogieron pacientes procedentes de 64 países diferentes, siendo los más frecuentes Argentina, Ecuador y Colombia. El índice de frecuentación fue mayor en pacientes españoles. Los pacientes extracomunitarios consultaron más por patología inflamatoria, mientras que los españoles y comunitarios consultaron principalmente por tumores benignos. En un 2% del global el motivo de consulta fue una enfermedad de transmisión sexual. Un 14,1% de los pacientes consultó por motivo considerado como «estético». Conclusiones: La demanda asistencial de la población inmigrante en Dermatología es menor respecto a la de la población autóctona, aunque con diferentes peculiaridades según el área de procedencia (AU)

Introduction: Spain has come to be one of the main European destinations for immigrants from countries with low per capita incomes. The Balearic Islands have the second largest proportion of immigrants in a Spanish autonomous community. The aim of this study was to describe the dermatology service utilization by immigrant and Spanish populations at Hospital Son Llàtzer in Palma de Majorca, Spain. Patients and methods: A longitudinal, descriptive study was undertaken to analyze first visits to the dermatology department of Hospital Son Llàtzer between July 10, 2007 and July 9, 2008. Results: Of the 6699 first visits, 13.2% were by non-Spanish patients, originating from 64 different countries, with Argentina, Ecuador, and Columbia the most common. Spanish patients consulted more frequently than non-Spanish patients. Patients from outside the European Union consulted most often for inflammatory conditions, whereas patients from Spain and other countries of the European Union mainly consulted for benign tumors. Consultations were for sexually transmitted disease in 2% of visits. The reason for the visit was classified as cosmetic in 14.1% of patients. Conclusions: The dermatology service utilization by the immigrant population was lower than by Spanish patients, although with differences according to the country of origin (AU)

[Initial evaluation, diagnosis, staging, treatment, and follow-up of patients with primary cutaneous malignant melanoma. Consensus statement of the Network of Catalan and Balearic Melanoma Centers]. / Valoración inicial, diagnóstico, estadificación, tratamiento y seguimiento de los pacientes con melanoma maligno primario de la piel. Documento de consenso de la "Xarxa de Centres de Melanoma de Catalunya i Balears"

The consensus statement on the management of primary cutaneous melanoma that we present here was based on selection, discussion, review, and comparison of recent literature (including national and international guidelines). The protocols for the diagnosis, treatment, and follow-up used in the hospital centers throughout Catalonia and the Balearic Isles belonging to the Network of Catalan and Balearic Melanoma Centers were also considered. The main objective of this statement was to present the overall management of melanoma patients typically used in our region at the present time. As such, the statement was not designed to be an obligatory protocol for health professionals caring for this group of patients, and neither can it nor should it be used for this purpose. Professionals reading the statement should not therefore consider it binding on their practice, and in no case can this text be used to guarantee or seek responsibility for a given medical opinion. The group of dermatologists who have signed this statement was created 3 years ago with the aim of making our authorities aware of the importance of this complex tumor, which, in comparison with other types of cancer, we believe does not receive sufficient attention in Spain. In addition, the regular meetings of the group have produced interesting proposals for collaboration in various epidemiological, clinical, and basic applied research projects on the subject of malignant melanoma in our society.

Valoración inicial, diagnóstico, estadificación, tratamiento y seguimiento de los pacientes con melanoma maligno primario de la piel. Documento de consenso de la 'Xarxa de Centres de Melanoma de Catalunya i Balears' / Initial evaluation, diagnosis, staging, treatment, and follow-up of patients with primary cutaneous malignant melanoma. Consensus statement of the network of Catalan and Balearic Melanoma Centers

El documento de consenso respecto al manejo del melanoma primario de la piel, que detallamos a continuación, nace de la puesta en común, aceptación, revisión y confrontación con la literatura reciente (incluyendo guías clínicas nacionales e internacionales), así como de los protocolos de diagnóstico, seguimiento y tratamiento consensuados en los diferentes centros hospitalarios de toda Cataluña y Balerares pertenencientes a la Xarxa de Centres de Melanoma de Catalunya i Balears. El objetivo principal de este documento es exponer de forma conjunta el manejo habitual del paciente con melanoma que actualmente se realiza en nuestro medio. Sin embargo, este documento no pretende, ni puede, por lo que tampoco debiera ser usado como un protocolo de obligado cumplimiento por los profesionales que atendemos a este grupo de enfermos. En este sentido, cabe mencionar que la consulta de este documento por parte del profesional no es vinculante para su acción, y en ningún caso este texto podrá ser utilizado para garantizar o buscar responsabilidades del juicio médico concreto. El grupo de dermatólogos que firman dicho documento se formó hace ahora tres años, con la intención de dar a conocer a nuestras autoridades la importancia de este complejo tumor, que en nuestro país creemos que se encuentra erróneamente infravalorada con respecto a otros tipo de cáncer. Además, fruto de las reuniones periódicas del grupo, han surgido también interesantes propuestas de colaboración en distintos proyectos de investigación epidemiológica, clínica y básica aplicada en torno al melanoma maligno en nuestra sociedad (AU)

The consensus statement on the management of primary cutaneous melanoma that we present here was based on selection, discussion, review, and comparison of recent literature (including national and international guidelines). The protocols for the diagnosis, treatment, and follow-up used in the hospital centers throughout Catalonia and the Balearic Isles belonging to the Network of Catalan and Balearic Melanoma Centers were also considered. The main objective of this statement was to present the overall management of melanoma patients typically used in our region at the present time. As such, the statement was not designed to be an obligatory protocol for health professionals caring for this group of patients, and neither can it nor should it be used for this purpose. Professionals reading the statement should not therefore consider it binding on their practice, and in no case can this text be used to guarantee or seek responsibility for a given medical opinion. The group of dermatologists who have signed this statement was created 3 years ago with the aim of making our authorities aware of the importance of this complex tumor, which, in comparison with other types of cancer, we believe does not receive sufficient attention in Spain. In addition, the regular meetings of the group have produced interesting proposals for collaboration in various epidemiological, clinical, and basic applied research projects on the subject of malignant melanoma in our society (AU)

Dermoscopy of cutaneous leishmaniasis.

BACKGROUND: Dermoscopy has been proposed as a diagnostic tool in the case of skin infections and parasitosis but no specific dermoscopic criteria have been described for cutaneous leishmaniasis (CL). OBJECTIVES: To describe the dermoscopic features of CL. METHODS: Dermoscopic examination (using the DermLite Foto; 3Gen, LLC, Dana Point, CA, U.S.A.) of 26 CL lesions was performed to evaluate specific dermoscopic criteria. RESULTS: We observed the following dermoscopic features: generalized erythema (100%), 'yellow tears' (53%), hyperkeratosis (50%), central erosion/ulceration (46%), erosion/ulceration associated with hyperkeratosis (38%) and 'white starburst-like pattern' (38%). Interestingly, at least one vascular structure described in skin neoplasms was observed in all cases: comma-shaped vessels (73%), linear irregular vessels (57%), dotted vessels (53%), polymorphous/atypical vessels (26%), hairpin vessels (19%), arborizing telangiectasia (11%), corkscrew vessels (7%) and glomerular-like vessels (7%). Combination of two or more different types of vascular structures was present in 23 of 26 CL lesions (88%), with a combination of two vascular structures in 13 cases (50%) and three or more in 10 cases (38%). CONCLUSIONS: Characteristic dermoscopic structures have been identified in CL. Important vascular patterns seen in melanocytic and nonmelanocytic tumours are frequently observed in this infection.

Dermoscopic findings in pyogenic granuloma.

BACKGROUND: To the best of our knowledge, no specific dermoscopic criteria have been described in the medical literature for the diagnosis of pyogenic granuloma. OBJECTIVES: To evaluate the morphological findings of pyogenic granuloma under dermoscopic observation. METHODS: Dermoscopic examination (using the DermLite Foto; 3Gen, LLC, Dana Point, CA, U.S.A.) of 13 patients with pyogenic granulomas was performed to evaluate specific dermoscopic criteria. RESULTS: The most frequently occurring dermoscopic features were found to be: reddish homogeneous area (92%), white collarette (85%), "white rail" lines that intersect the lesion (31%) and ulceration (46%). The results of our study reveal that the absence of specific dermoscopic criteria for other skin tumours and a reddish homogeneous area surrounded by a white collarette are the most frequent dermoscopic pattern in pyogenic granulomas (85%). CONCLUSIONS: Dermoscopy is a useful tool for improving the recognition of pyogenic granuloma.

Dermoscopic findings of haemosiderotic and aneurysmal dermatofibroma: report of six patients.

BACKGROUND: The clinical diagnosis of dermatofibroma is commonly easy. However, the differentiation of dermatofibroma from other cutaneous tumours is difficult in some instances, primarily in atypical cases and rare variants. Haemosiderotic dermatofibroma is a variant composed of numerous small vessels, extravasated erythrocytes and intra- and extracellular haemosiderin deposits. Aneurysmal dermatofibroma is a variant composed of large, blood-filled spaces without endothelial lining. Some authors consider that haemosiderotic dermatofibroma is an early stage in the development of aneurysmal dermatofibroma. The clinical differential diagnosis of haemosiderotic or aneurysmal dermatofibroma must include melanoma and other melanocytic tumours, vascular neoplasms, adnexal tumours and nonspecific cysts. Dermoscopy improves the diagnostic accuracy in pigmented and nonpigmented skin lesions. OBJECTIVES: To evaluate specific dermoscopic criteria. METHODS: Dermoscopic examination (using the DermLite Foto; 3Gen, LLC, Dana Point, CA, U.S.A.) of six patients with haemosiderotic or aneurysmal dermatofibromas was performed to evaluate specific dermoscopic criteria. RESULTS: A multicomponent pattern with a central bluish or reddish homogeneous area in combination with white structures and a peripheral delicate pigment network along with vascular structures was noted in five of six lesions. CONCLUSIONS: This dermoscopic pattern yielded the diagnosis of haemosiderotic or aneurysmal dermatofibroma in most cases. However, this multicomponent pattern may present in some melanomas and although it is useful in determining a clinical diagnosis of aneurysmal dermatofibroma, it may not be specific to this entity.

Dermoscopy is useful for the recognition of benign-malignant compound tumours.

The association of two different neoplasms in the same lesion is uncommon and has been reported as collision or compound tumours in the medical literature. In cases where a malignant neoplasm exists in association with a benign lesion it is important to make an accurate diagnosis in order to treat the lesions correctly. Dermoscopy is an in vivo, noninvasive technique that improves the clinical accuracy in diagnosing melanoma and other pigmented skin lesions. We describe the dermoscopic characteristics of various collision or compound tumours that were composed of benign and malignant neoplasms: two cases of seborrhoeic keratosis associated with basal cell carcinoma, two cases of melanocytic naevus and basal cell carcinoma and one case of dermatofibroma associated with basal cell carcinoma. We conclude that dermoscopy is a useful tool for improving the recognition of these kinds of tumours.

Sarcoidosis and pyoderma gangrenosum: an exceptional association. The role of trauma and immunosuppressive agents.

The coexistence of sarcoidosis and pyoderma gangrenosum has rarely been reported. We have found only three cases in our review of the literature. Herein, we report a new case and discuss the role of trauma and immunosuppression in the development of PG, and the efficacy of cyclosporin A in PG and sarcoidosis.

Tromboangeítis obliterante

La tromboangeítis obliterante (TAO) o enfermedad de Buerger es una vasculitis de etiología desconocida, aunque con un factor predisponente destacado, el tabaco. Afecta predominantemente a varones jóvenes, entre 20 y 40 años. Las manifestaciones clínicas dependen del órgano afectado pero en su mayoría corresponden a isquemia de las extremidades, siendo la claudicación intermitente el motivo de consulta más frecuente. El diagnóstico se establece a partir de la sospecha clínica pues los criterios son variados y engloban desde manifestaciones clínicas a hallazgos de la arteriografía y anatomía patológica.No existe un tratamiento específico de la enfermedad y el factor pronóstico más importante es el abandono del hábito tabáquico. (AU)