[Translated article] Melanoma Registry of the Spanish Academy of Dermatology and Venereology (REGESMEL): Description and Data in its First Year of Operation.

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.

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.

Ustekinumab treatment for moderate to severe psoriasis. Eight-year real-world follow-up of 61 cases in a tertiary level hospital.

Background: Efficacy and safety profiles of ustekinumab have been proved in numerous clinical trials. However, relevant variations with daily practice have been shown and few studies value the long-term response maintenance.Objective: To evaluate the efficacy of long-term ustekinumab therapy in patients with moderate-to-severe plaque-type psoriasis in a real-world setting.Methods: Observational retrospective follow-up study including, patients receiving ustekinumab at least 3 months in our department. Efficacy was expressed as percentage of patients achieving Psoriasis area and severity index (PASI) 50, PASI75, and PASI90 and maintaining PASI ≤5, ≤3, and 0 every 3 months during the first year of treatment, and every 12 months to the end of follow-up or to withdrawal from the study.Results: Sixty-one patients. Fifty patients had previously been treated with other biologic therapies. The percentage of patients maintaining PASI90 was 72.1, 78.3, 70.0, 83.3, 96.2, 91.7, and 100.0%, and PASI value maintained 0 in 68.9, 73.9, 67.50, 80.6, 96.2, 91.7, and 100.0% at 3, 12, 24, 36, 60, 84, and 96 months. Ustekinumab was discontinued in 26.2% of patients. No patients were withdrawn because of adverse events.Conclusions: This real world-setting study shows maintenance of long-term efficacy and safety of ustekinumab treatment in moderate-severe plaque psoriasis in daily practice through 8 years.

Melanoma cutáneo en el anciano: revisión de un problema creciente / Cutaneous Melanoma in the Elderly: Review of a Growing Problem

El melanoma cutáneo (MC) es el tumor cutáneo que más muertes provoca, con un aumento importante de la incidencia y la mortalidad en las últimas décadas, especialmente en el paciente anciano. Existen evidencias del diferente comportamiento biológico, así como de las diferencias en el manejo del MC en este subgrupo de pacientes con respecto al resto de otras franjas de edad, evidentemente condicionadas por unas limitadas expectativas de supervivencia y calidad de vida ajenas al melanoma y una elevada incidencia de comorbilidades. El presente artículo revisa los datos actuales más relevantes de la epidemiología, etiopatogenia e inmunología, clínica, prevención y manejo del MC en el anciano

Cutaneous melanoma (CM) causes more deaths than any other skin tumor, and incidence and mortality rates have risen in recent years, especially in patients of advanced age. There are differences in the biological behavior of CM tumors in the elderly as well as differential management of the disease, evidently influenced by such factors as limited life expectancy, the high incidence of concomitant conditions in older patients, and issues of quality of life unrelated to CM itself. We review relevant current literature on the epidemiology, etiology, pathogenesis, and immunology of CM as well as research on the clinical features, prevention, and management of these tumors in the elderly

Cutaneous Melanoma in the Elderly: Review of a Growing Problem. / Melanoma cutáneo en el anciano: revisión de un problema creciente.

Cutaneous melanoma (CM) causes more deaths than any other skin tumor, and incidence and mortality rates have risen in recent years, especially in patients of advanced age. There are differences in the biological behavior of CM tumors in the elderly as well as differential management of the disease, evidently influenced by such factors as limited life expectancy, the high incidence of concomitant conditions in older patients, and issues of quality of life unrelated to CM itself. We review relevant current literature on the epidemiology, etiology, pathogenesis, and immunology of CM as well as research on the clinical features, prevention, and management of these tumors in the elderly.

Infliximab drug and antibody levels in patients with dermatological conditions.

BACKGROUND: In recent years, studies monitoring infliximab in rheumatoid arthritis and inflammatory bowel disease have confirmed the relationship between the clinical response and the infliximab and anti-infliximab antibodies serum levels. However, there is only limited evidence in the field of dermatology. OBJECTIVE: The aim of this study was to establish the correlation between plasma infliximab levels, the presence of anti-infliximab antibodies and the clinical response in dermatological conditions. SETTING: Retrospective observational study in a tertiary hospital (University Hospital of La Coruña, Spain). METHOD: Patients with dermatological conditions being treated with infliximab (5 mg/kg/8 weeks after the induction dose) were included in the study. The concentrations of infliximab and anti-infliximab antibodies were quantified by two sandwich-type ELISA immunoassays. The patients were classified into three groups based on the efficacy: good, partial or non-efficacy at the time of each blood assessment. The development of adverse reactions was also evaluated. MAIN OUTCOME MEASURES: Plasma levels of infliximab and anti-infliximab antibodies, clinical response and infusion reactions. RESULTS: 17 patients (45 assessments) were included. The good/partial efficacy rate was significantly higher in the case of >0.05 than <0.05 µg/mL infliximab concentration (93.3 vs. 40.0 %, p < 0.001). Anti-infliximab antibodies were only detected in five samples. Their presence was associated with a higher frequency of infusion reactions and a lower efficacy rate in comparison with the group without antiinfliximab antibodies (100.0 vs. 0.0 %, p < 0.001 and 0.0 vs. 85.0 %, p < 0.001 respectively). CONCLUSIONS: The results obtained show that the presence of infliximab concentrations higher than 0.05 µg/mL are correlated with a good clinical response and the absence of toxicity. The incidence of anti-infliximab antibodies is low, although a correlation was observed between the presence of antibodies, absence of infliximab concentration, loss of clinical response and the development of infusion reactions.

Spitzoid and non-spitzoid melanoma in children: a prognostic comparative study.

BACKGROUND: Spitzoid melanoma is a rare melanoma subtype often developing in children with unknown biological potential. OBJECTIVES: To compare the clinical and histopathological factors that influence the biological behaviour between spitzoid and non-spitzoid childhood melanoma, to establish if the spitzoid subset of melanoma has different prognosis than other types of childhood melanomas. METHODS: A comparison of the prognostic significance of clinical and pathological findings between 38 spitzoid (SM) and 99 non-spitzoid melanomas (N-SM) in children and teenagers younger than 18 years referred to UT - MD Anderson Cancer Center during the period 1992-2007. RESULTS: Children with SM were significantly younger than those with N-SM, had more frequently multiple melanocytic nevi, nodular melanoma subtype with vertical growth phase, high Breslow thickness and mitotic rate, positive sentinel lymph node biopsy and more advanced stage. N-SM had more often associated nevus. However, the mortality rate in the SM group was lower (5.9%) than in the N-SM group (12.0%). This study has two major limitations. Small size of both groups does not allow reaching statistically significant differences regarding mortality. Using metastatic potential as an inclusion criterion for SM could result in a sample selection bias of the most aggressive group of SM. CONCLUSIONS: Although SM patients had poorer prognostic factors than N-SM patients, slightly lower mortality rate was detected in the SM group. This less aggressive behaviour could be due to lower potential for widespread distant metastases than conventional melanomas or younger age of children with SM.

Psoriasis in patients older than 65 years. A comparative study with younger adult psoriatic patients.

OBJECTIVES: To examine the clinical characteristics of psoriasis, prevalence of comorbidities and quality of life in psoriasis patients older than 65 years and to compare them with younger adult psoriatic patients. DESIGN: Prospective observational study of prevalence. SETTING AND PARTICIPANTS: Patients older than 18 years with diagnosis of psoriasis attended at the Dermatology Department of the University Hospital of A Coruña (Galicia, Spain). A total of 371 patients were included (218 males and 153 females) with ages ranging from 18 to 85 years, of whom 70 were older than 65 years. MEASUREMENTS: Demographic data, clinical characteristics and psoriasis treatment, history of hypertension, diabetes mellitus, smoking and alcohol consumption and quality of life impairment were registered. Body mass index, waist-hip ratio, left ventricular hypertrophy, average value of systolic and diastolic blood pressure, cholesterol, triglycerides and glucose blood levels were also measured. RESULTS: Patients older than 65 years have statistically significant higher prevalence of hypertension, left ventricular hypertrophy, waist-hip ratio, diabetes mellitus and raised blood glucose levels. There was also association between clinical severity of psoriasis and smoking and alcohol intake as well as between quality of life and type of psoriasis treatment. CONCLUSIONS: Psoriasis in patients older than 65 years represents a significant proportion of cases and its prevalence is expected to increase. Because these patients are more prone to suffer comorbidities and to develop adverse effects due to psoriasis treatment, attention to pharmacologic interactions and correction of cardiovascular risk factors and toxic habits should be especially taken in mind in this age group.

Complications of ambulatory major dermatological surgery in patients older than 85 years.

BACKGROUND: During the last decades, the progressive ageing of the population has resulted in a rising skin cancer incidence. Although previous studies detected no higher morbidity for dermatological surgery in senior patients, their exclusion from optimal surgical treatment remains as a common clinical practice. OBJECTIVE: The aim of this study was to determine the diseases treated with ambulatory major dermatological surgery, the surgical morbidity and the associated variables in ≥ 85 year-old patients. PATIENTS/METHODS: This is an observational study on 247 successive patients older than 85 years of age who underwent dermatological surgery in a single Ambulatory Mayor Surgery unit. Studied variables were age, gender, tobacco-alcohol exposure, co-morbid medical conditions, blood-thinning medication, antibiotic prophylaxis, number of lesions, location, histopathological diagnosis, area of skin removed, surgical technique, type of flap, length of surgery, entrance order, suture thread, surgical complications and need of post-operative admission. RESULTS: The most common site was head and neck (82.7%). The most frequent tumour was basal cell carcinoma (45.1%), followed by squamous cell carcinoma (38.7%) and melanoma (8.3%). Direct closure was the most frequent procedure (55.6%). Of the total number of patients, 7.9% of patients suffered complications; necrosis followed by cellulitis were the most frequent. Length of surgical procedure, area of skin removed and reconstruction with skin-graft were significantly related to higher risk of post-operative complications. CONCLUSIONS: No intra or post-surgical mortality or life-threatening local complications were detected. Most post-surgical local complications appeared after wide excisions and complex reconstruction techniques that prolonged the length of the surgery.

[Controversial issues in congenital nevi]. / Controversias en el nevus congénito.

Congenital melanocytic nevi are very common lesions that nevertheless pose many controversial questions. A systematic review of the literature suggests that the risk of developing melanoma on giant congenital melanocytic nevi (GCMN) is lower than previously thought given that, in the most recent series of GCMN, only 2 % of patients developed melanoma and most did so before the age of 5 years. Therefore,prophylactic surgery should be considered on an individual basis according to the degree of clinical suspicion of melanoma and the esthetic and functional consequences.In extensive reviews of series of biopsies of melanoma, small congenital melanocytic nevi have been associated with 7 % to 8 % of cases. Many authors believe that these might represent a significant risk of malignant conversion from 10 years onwards and so recommend regular control visits during infancy and prophylactic exeresis in puberty.

Controversias en el nevus congénito / Controversial Issues in Congenital Nevi

Los nevus melanocíticos congénitos son lesiones muy frecuentes, pero que todavía plantean muchas cuestiones que son motivo de controversia. Una revisión sistématica de la literatura sugiere que el riesgo de desarrollar melanoma sobre nevus melanocíticos congénitos gigantes (NMCG) es inferior al que se postuló históricamente. En las series de NMCG más recientes sólo un 2 % de pacientes desarrolló un melanoma y la mayoría lo hizo antes de los 5 años de edad. Por tanto, su tratamiento quirúrgico profiláctico debe ser individualizado en función de la sospecha clínica de melanoma y de las consecuencias estéticas y funcionales. En revisiones amplias de biopsias de melanoma se han encontrado NMC pequeños asociados en un 7-8 % de los casos. Muchos autores consideran que podrían tener un riesgo de malignización significativo a partir de la segunda década de vida, por lo que recomiendan la vigilancia periódica durante la infancia y la exéresis profiláctica en la pubertad (AU)

Congenital melanocytic nevi are very common lesions that nevertheless pose many controversial questions. A systematic review of the literature suggests that the risk of developing melanoma on giant congenital melanocytic nevi (GCMN) is lower than previously thought given that, in the most recent series of GCMN, only 2 % of patients developed melanoma and most did so before the age of 5 years. Therefore, prophylactic surgery should be considered on an individual basis according to the degree of clinical suspicion of melanoma and the esthetic and functional consequences. In extensive reviews of series of biopsies of melanoma, small congenital melanocytic nevi have been associated with 7 % to 8 % of cases. Many authors believe that these might represent a significant risk of malignant conversion from 10 years onwards and so recommend regular control visits during infancy and prophylactic exeresis in puberty (AU)

Interface dermatitis in skin lesions of Kikuchi-Fujimoto's disease: a histopathological marker of evolution into systemic lupus erythematosus?

Kikuchi's disease (KD) is a self-limiting histiocytic necrotizing lymphadenitis (HNL). Cutaneous manifestations are frequent and usually show histopathological findings similar to those observed in the involved lymph nodes. HNL with superposed histological features to KD has been described in patients with lupus erythematosus (LE), and a group of healthy patients previously reported as having HNL may evolve into LE after several months. Up to date, features to predict which HNL patients will have a self-limiting disease and which could develop LE have been not identified. In order to clarify the characteristics of skin lesions associated with KD, we report a case of HNL with evolution into systemic lupus erythematosus (SLE) and a review of previous reports of KD with cutaneous manifestations. A 17-year-old woman presented with a 4-month history of fever and generalised lymphadenopathy. A diagnosis of HNL was established based on a lymph node biopsy. One month later, she developed an erythematoedematous rash on her upper body, with histopathological findings of interface dermatitis. After 8 months, anti-nuclear antibodies (ANA) at titre of 1/320, anti-DNA-ds antibodies and marked decrease of complement levels were detected. During the following 2 years, she developed diagnostic criteria for SLE, with arthralgias, pleuritis, aseptic meningitis, haemolytic anaemia and lupus nephritis. To our knowledge, 27 cases of nodal and cutaneous KD have been reported, 9 of which later developed LE. In all these patients, the skin biopsy revealed interface dermatitis. Skin biopsy revealed a pattern of interface dermatitis in all reviewed KD cases, which evolved into LE. Even this histopathological finding was not previously considered significant; it might be a marker of evolution into LE.

Toxic epidermal necrolysis-like acute cutaneous lupus erythematosus.

The term "Acute Syndrome of Apoptotic Pan-Epidermolysis" (ASAP) designs clinical entities characterized by massive cleavage of the epidermis resulting from hyperacute epidermal basal cell apoptotic injury. It can be seen typically in classic toxic epidermal necrolysis (TEN), but occasionally occurs in non-drug-induced entities called "TEN-like" diseases (e.g., lupus erythematosus (LE), acute graft versus host disease and pseudoporphyria). We would like to highlight the difficulties of establishing differential diagnoses between "TEN-like" LE and drug reactions, especially when LE has not been previously diagnosed. We report a patient with fulminate pattern of epidermal cell injury resulting in a clinical presentation having combined features of drug-induced TEN and acute cutaneous LE with laboratory findings of systemic LE (SLE) and without systemic symptoms or high-risk drug ingestion. Although most cases of ASAP in the setting of LE are drug-induced TEN, there are reported cases of "TEN-like" LE with subacute progression, absence of systemic involvement and lack of drug ingestion. Such cases usually have a previous history of SLE and positive serologic markers. Although some authors observed that these lesions could be related to systemic severity of SLE, this is the first patient reported who progresses to discoid LE and we think it could be a marker of good prognosis.

[Pancreatic panniculitis. Report of a case and review of literature]. / Presentación de un caso de paniculitis pancreática y revisión de la bibliografía.

Pancreatic panniculitis is an uncommon complication of pancreatic disease, which is characterized by liquefactive necrosis of the subcutaneous fat and may constitute the first evidence of a pancreatic illness. Herein, we report a case where cutaneous lesions of pancreatic disease were recognized prior to detection of an acute episode of a known chronic pancreatitis.

Outpatient dermatology major surgery: a 1-year experience in a Spanish tertiary hospital.

INTRODUCTION: The constant increase in the incidence of skin cancer together with the requirement for maximum exploitation of available medical resources has meant that dermatological major surgery on an outpatient basis has greatly increased in recent years. OBJECTIVE: This article reviews the practice of dermatological surgery in an outpatient setting over a 1-year period. Its purpose is to analyse the number of surgical procedures, the type of cutaneous processes treated and the kind of surgical intervention and anaesthesia used. We also assessed the percentage of cancellations, postsurgical hospital admission and postsurgical complications. Clinicopathological correlation and complete tumour removal were also evaluated. MATERIAL AND METHODS: Our clinical experience of major surgery of outpatients at the dermatology department of the Hospital Juan Canalejo in A Coruña (Spain), analysing 565 patients in a non-randomized pilot study running from January to December 2003, is presented. RESULTS: Six hundred and forty-four surgical procedures were performed on a total of 565 patients. The three main cutaneous processes treated were basal cell carcinoma (240), squamous cell carcinoma (117) and melanoma (77). The most frequent type of procedure was direct closure (346), followed by exeresis and flap (133) and partial- or full-thickness skin graft (29), nail apparatus surgery (56) and lip surgery (33). Twelve patients were admitted to hospital after surgery owing to the complexity of their operations or to complications arising during surgery. Five hundred and fifty-three patients were discharged after being kept under observation for a few hours. Seventeen patients (3%) suffered complications following surgery, which consisted of partial implant failure (six cases), infection of the surgical wound (six cases), intense pain (four cases) and haemorrhage (one case). There was a good clinicopathological correlation in 90.78% of non-melanoma skin cancers, of which 92.03% were completely removed. CONCLUSIONS: Medium and high complexity operations for dermatological processes, traditionally performed on hospitalized patients, can be conducted on an outpatient basis. This allows hospitalization costs and waiting lists to be reduced and affords the possibility of achieving better morbidity rates and medical care than in the standard hospital setting.