Sentinel Lymph Node Biopsy in Patients With Thick Primary Cutaneous Melanoma.

BACKGROUND: The clinical value of sentinel lymph node biopsy (SLNB) in patients with thick melanoma is uncertain. The purpose of this study was to investigate the correlations between survival and lymph node status in thick melanomas. METHODS: Of a total of 736 melanoma patients registered between 2000 and 2016, 50 presented with thick melanomas (≥ 4.0 mm) without distant metastatic disease. All patients were examined with a whole-body magnetic resonance imaging, or computed tomography, and positron emission tomography-computed tomography depending on the incorporation of the new technology in our medical institutions. They were studied according to the following procedure: 1) preoperative determination of regional lymph node along with the estimation and localization of sentinel lymph node (SLN) (dynamic isotope lymphography); 2) intraoperative localization and SLNB (lymphatic mapping); and 3) histopathology. Patient and tumor features were collected. RESULTS: Mean follow-up was 40 months, and 37% had a follow-up ≥ 5 years. A positive SLN was identified in 28 patients (56%). No significant difference in melanoma-specific overall survival was observed in terms of the primary tumor site. Hazard ratios (HRs) were statistically significant for SLNB-positive group and mitotic rate (MR) > 3 mm2, but not for presence of ulceration. Mortality risk in the SLN-positive group was almost fourfold greater than that in the SLN-negative group at any time of follow-up. CONCLUSIONS: SLN status, along with MR, can provide valuable prognostic information in patients with thick primary cutaneous melanoma.

High prevalence of Gammapapillomaviruses (Gamma-PVs) in pre-malignant cutaneous lesions of immunocompetent individuals using a new broad-spectrum primer system, and identification of HPV210, a novel Gamma-PV type.

Genus Gammapapillomavirus (Gamma-PV) is the most diverse and largest clade within the Papillomaviridae family. A novel set of degenerate primers targeting the E1 gene was designed and further used in combination with the well-known CUT PCR assay to assess HPV prevalence and genus distribution in a variety of cutaneous samples from 448 immunocompetent individuals. General HPV, Gamma-PV and mixed infections prevalence were significantly higher in actinic keratosis with respect to benign and malignant neoplasms, respectively (p = 0.0047, p = 0.0172, p = 0.00001). Gamma-PVs were significantly more common in actinic keratosis biopsies than Beta- and Alpha-PVs (p = 0.002). The full-length genome sequence of a novel putative Gamma-PV type was amplified by 'hanging droplet' long-range PCR and cloned. The novel virus, designated HPV210, clustered within species Gamma-12. This study provides an additional tool enabling detection of HPV infections in skin and adds new insights about possible early roles of Gamma-PVs in the development of cutaneous malignant lesions.

Dermoscopic findings in an early malignant fibrous histiocytoma on the face.

Malignant fibrous histiocytoma (MFH), currently classified as undifferentiated pleomorphic sarcoma, is the most frequent soft tissue sarcoma in adulthood, but it is not as common as a primary skin tumor. MFH affects mostly the thighs and trunk, head and neck is an infrequent presentation in adults. MFH is often diagnosed in advanced stages, with a tendency to local recurrence and systemic metastasis. Since tumor thickness and size are identified as major prognostic factors, early recognition becomes crucial to improve prognosis. We present a case of a cutaneous malignant fibrous histiocytoma located on the face in which dermoscopy was useful in clinical management and definition.

Eritrodisestesia o síndrome mano pie. Presentación de dos casos y revisión de la literatura / Erythrodysesthesia or foot hand syndrome Presentation of two cases and review of the literature

La eritrodisestesia, o síndrome mano pie, es una reacción adversa relacionada con algunos agentes quimioterápicos. Se caracteriza por comenzar con un pródromo de disestesia palmo-plantar y, entre 2 a 4 días, la sensación progresa a un dolor quemante con edema y eritema en placas bien delimitadas y simétricas. Los quimioterápicos que se asocian con más frecuencia son la doxorrubicina, 5-fluorouracilo, capecitabina, citarabina y docetaxel. Es más frecuente y severo en mujeres, pacientes de edad avanzada o con compromiso vascular periférico. Se presentan dos pacientes de sexo femenino. La primera con cáncer de ovario en tratamiento con doxorrubicina liposomal que presentó eritrodisestesia luego del quinto ciclo de quimioterapia. La segunda paciente con diagnóstico de cáncer de mama que recibió tratamiento con capecitabina presentando síntomas luego del segundo ciclo de quimioterapia. El interés de la presentación es la consulta a dermatología por un síndrome que constituye un efecto adverso que potencialmente limita el uso de determinados antineoplásicos. Sin embargo, educando al paciente, con intervenciones farmacológicas y ajuste de dosis, es posible aliviar los síntomas continuando una terapéutica efectiva (AU)

Erythrodysesthesia, or hand foot syndrome, is a side effect related to some chemotherapeutic agents. It is characterized by a prodrome of palmoplantar dysesthesia followed by burning pain with edema and erythema on well-defined and symmetrical plaques, 2-4 days later. Doxorubicin, 5-fluorouracil, capecitabine, cytarabine and docetaxel are the most frequently associated chemotherapy drugs. Women, elderly or peripheral vascular compromise patients are more frequent and severe affected. Two female patients are reported. The first patient with ovarian cancer in treatement with liposomal doxorrubicin developed erythrodysesthesia after the fifth cycle of chemotherapy. Meanwhile the second patient diagnosed with breast cancer in treatment with capecitabine developed it after the second cycle of chemotherapy. The interest of this report is the dermatological consultation about a side effect syndrome which potentially limits the prescription of certain antineoplastic drugs. However, patients can continue specific treatment by indicating dose adjustment and prescribing medicine to relieve the symptoms (AU)

Characterization of novel human papillomavirus types 157, 158 and 205 from healthy skin and recombination analysis in genus γ-Papillomavirus.

Gammapapillomavirus (γ-PV) is a diverse and rapidly expanding genus, currently consisting of 79 fully characterized human PV (HPV) types. In this study, three novel types, HPV157, HPV158 and HPV205, obtained from healthy sun-exposed skin of two immunocompetent individuals, were amplified by the "Hanging droplet" long PCR technique, cloned, sequenced and characterized. HPV157, HPV158 and HPV205 genomes comprise 7154-bp, 7192-bp and 7298-bp, respectively, and contain four early (E1, E2, E6 and E7) and two late genes (L1 and L2). Phylogenetic analysis of the L1 ORF placed all novel types within the γ-PV genus: HPV157 was classified as a new member of species γ-12 while HPV158 and HPV205 belong to species γ-1. We then explored potential recombination events in genus γ-PV with the RDP4 program in a dataset of 74 viruses (71 HPV types with available full-length genomes and the 3 novel types). Two events, both located in the E1 ORF, met the inclusion criterion (p-values <0.05 with at least four methods) and persisted in different ORF combinations: an inter-species recombination in species γ-8 (major and minor parents: species γ-24 and γ-11, respectively), and an intra-species recombination in species γ-7 (recombinant strain: HPV170; major and minor parents: HPV-109 and HPV-149, respectively). These findings were confirmed by phylogenetic tree incongruence analysis. An additional incongruence was found in members of species γ-9 but it was not detected by the RDP4. This report expands our knowledge of the family Papillomaviridae and provides for the first time in silico evidence of recombination in genus γ-PV.

Gonadoblastoma: an unusual ovarian tumor.

Gonadoblastomas are unusual benign neoplasias that frequently appear in the dysgenetic gonads of women with chromosome Y anomaly. In this study, we reviewed 3 gonadoblastoma cases, 2 of which were bilateral, in patients 21, 17, and 18 years of age. Two of them presented 46 XY karyotype and gonadal dysgenesis, whereas the third presented 46 XX karyotype. Besides, 2 of the cases were associated to dysgerminomas. In all the cases, the histologic examination showed germ cell proliferation and sex cords derivatives frequently surrounding small round deposits containing amorphous hyaline material resembling Call-Exner bodies. One of the patients died at 8 years from diagnosis because of dysgerminoma multiple metastases, one is alive with no evidence of disease at the second year of follow-up, and the evolution of the third patient remains unknown.

New generic primer system targeting mucosal/genital and cutaneous human papillomaviruses leads to the characterization of HPV 115, a novel Beta-papillomavirus species 3.

We explored the cutaneotropic HPV genetic diversity in 71 subjects from Argentina. New generic primers (CUT) targeting 88 mucosal/cutaneous HPV were designed and compared to FAP primers. Overall, 69 different HPV types/putative types were identified, being 17 of them novel putative types. Phylogenetic analysis of partial L1 sequences grouped 2 novel putative types in the Beta-PV, 14 in the Gamma-PV and 1 in the Mu-PV genera. CUT primers showed broader capacity than FAP primers in detecting different genera/species and novel putative types (p<0.01). Using overlapping PCR, the full-length genome of a Beta-PV putative type was amplified and cloned. The new virus, designated HPV 115, encodes five early genes and two late genes. Phylogenetic analysis indicated HPV 115 as the most divergent type within the genus Beta-PV species 3. This report is the first providing data on cutaneous HPVs circulating in South America and expands our knowledge of the Papillomaviridae family.

Paracoccidiodiomicosis: a propósito de dos observaciones / Paracoccidiodiomicosis: about two observations

La paracoccidioidomicosis (PCM) es una micosis sitémica, granulomatosa y supurativa, de evolución subaguda o crónica, producida por un hongo dimorfo llamado Paracoccidioides brasiliensis. Las formas clínicas dependen del estado inmunológico del paciente. De no ser diagnosticada y tratada oportunamente puede llevar a un compromiso progresivo y fatal del paciente. A continuación se presentan dos casos clínicos y se realiza una revisión de la bibliografía.