Clustered yellow papules in the posterior axilla of a middle-aged woman.

Naevus lipomatosus cutaneous superficialis (NLCS) of Hoffman-Zurhelle is a rare hamartomatous benign condition first described in 1921. Two clinical variants have been described: a classical form of multiple yellow papules that coalesce to form larger plaques with segmental distribution, and a solitary form also known as pedunculated lipofibroma. We present a case of early-stage NLCS with characteristic histopathological and dermoscopic features.

Melanocytic lesions with peripheral globules: results of an observational prospective study in 154 high-risk melanoma patients under digital dermoscopy follow-up evaluated with reflectance confocal microscopy.

BACKGROUND: The management of melanocytic lesions with peripheral globules (MLPGs) is usually age-dependent and can be challenging in high-risk melanoma patients. OBJECTIVES: To evaluate clinical, dermoscopic and reflectance confocal microscopy (RCM) features of MLPG in patients under digital dermoscopic surveillance. To know whether dermoscopic or RCM findings correlate with histologic diagnosis and the accuracy of the dermoscopy-RCM compared with histopathology. METHODS: During 24 months, we prospectively enrolled MLPG in patients under digital dermoscopy follow-up. All were evaluated by dermoscopy and RCM and excised for histologic examination. RESULTS: We enrolled 154 patients, mean age 42.45 years (18.78-73.19). Three melanomas and 19 dysplastic naevi (DNs) were diagnosed. There were no significant differences in the age of the patients (P = 0.662). MLPGs with diameter of 6 mm or more and asymmetry in two axes were associated with melanoma (P = 0.01, P = 0.003). Patients with more than one MLPG were less likely to have melanoma. Blue-grey and red colours were more frequent in melanoma (P = 0.013 and P = 0.000). Different sizes and shapes of PG were associated with DN and melanoma (P = 0.000 and P = 0.001). In a new lesion, PG in <25% of the circumference was related to malignancy (P = 0.010). RCM signs of malignancy were related to melanoma: pagetoid cells (P = 0.000), non-edged papillae (P = 0.001), atypical junctional thickenings (P = 0.000) and atypical cells at the dermal-epidermal junction (P = 0.000). Dense irregular nests were associated to melanoma (P = 0.019). Dermoscopy and confocal evaluation were able to diagnose 100% of melanomas and 84.21% of DNs. The kappa coefficient between dermoscopy-RCM vs. histology was 0.76. CONCLUSIONS: We recommend to excise a MLPG when it presents asymmetry in two axes, 6 or more mm, new lesion with PG in less than the 25% of the circumference, irregular size and shape PGs and irregular dense nests on RCM, regardless of the patient's age.

Carcinoma de células de Merkel: estudio descriptivo de 11 casos / Merkel Cell Carcinoma: A Description of 11 Cases

El carcinoma de células de Merkel (CCM) es una neoplasia neuroendocrina maligna. Con frecuencia existe diseminación ganglionar o metástasis al diagnóstico. Realizamos un estudio descriptivo retrospectivo de los pacientes con CMM del Hospital Universitario Fundación Alcorcón entre enero/1998 y diciembre/2018. En 21 años diagnosticamos 11 pacientes con CCM: 7 varones (63%) y 4 mujeres (36%), con una edad media de 77,6 años. El 45% de los pacientes presentaron un estadio IIIB (pTNM) al diagnóstico. Todos los pacientes menos uno, fueron subsidiarios de cirugía local, identificándose en 7 casos invasión linfovascular. Tras la cirugía, 5 pacientes recibieron radioterapia adyuvante y 3 quimioterapia adyuvante. El 54% fallecieron por el tumor (tiempo medio supervivencia: 14,5 meses). El CCM es una neoplasia maligna infrecuente cuya incidencia se sitúa en 0,18-0,41 casos/100.000 habitantes/año, similar a los 0,29-0,32 casos/100.000 habitantes/año registrados en nuestra serie. Recientemente ha sido aprobado avelumab para casos metastásicos con esperanzas prometedoras

Merkel cell carcinoma (MCC) is a malignant neuroendocrine tumor. Metastasis or lymph node spread is often detected at diagnosis. We performed a descriptive, retrospective study of patients diagnosed with MMC at Hospital Universitario Fundación Alcorcón in the Community of Madrid, Spain between January 1998 and December 2018. Eleven patients (7 men [63%] and 4 women [36%]; mean age, 77.6 years) were diagnosed with MCC during this 21-year period; 45% of patients had stage IIIB disease (pTNM) at diagnosis. All patients but one underwent local surgery, and lymphovascular invasion was detected in 7 cases. Eight patients received adjuvant therapy after surgery (radiation therapy in 5 cases and chemotherapy in 3). Six patients (54%) died of MCC (mean survival, 14.5 months). MCC is an uncommon malignant tumor with an annual incidence of around 0.18 to 0.41 cases per 100 000 inhabitants; this is similar to the rate of 0.29 to 0.32 cases per 100 000 inhabitants a year detected in our series. Results with avelumab, a drug recently approved for the treatment of metastatic MCC; have been promising

Merkel Cell Carcinoma: A Description of 11 Cases. / Carcinoma de células de Merkel: estudio descriptivo de 11 casos.

Merkel cell carcinoma (MCC) is a malignant neuroendocrine tumor. Metastasis or lymph node spread is often detected at diagnosis. We performed a descriptive, retrospective study of patients diagnosed with MMC at Hospital Universitario Fundación Alcorcón in the Community of Madrid, Spain between January 1998 and December 2018. Eleven patients (7 men [63%] and 4 women [36%]; mean age, 77.6 years) were diagnosed with MCC during this 21-year period; 45% of patients had stage IIIB disease (pTNM) at diagnosis. All patients but one underwent local surgery, and lymphovascular invasion was detected in 7 cases. Eight patients received adjuvant therapy after surgery (radiation therapy in 5 cases and chemotherapy in 3). Six patients (54%) died of MCC (mean survival, 14.5 months). MCC is an uncommon malignant tumor with an annual incidence of around 0.18 to 0.41 cases per 100 000 inhabitants; this is similar to the rate of 0.29 to 0.32 cases per 100 000 inhabitants a year detected in our series. Results with avelumab, a drug recently approved for the treatment of metastatic MCC; have been promising.

Early outcome of a 31-gene expression profile test in 86 AJCC stage IB-II melanoma patients. A prospective multicentre cohort study.

BACKGROUND: The clinical and pathological features of primary melanoma are not sufficiently sensitive to accurately predict which patients are at a greater risk of relapse. Recently, a 31-gene expression profile (DecisionDx-Melanoma) test has shown promising results. OBJECTIVES: To evaluate the early prognostic performance of a genetic signature in a multicentre prospectively evaluated cohort. METHODS: Inclusion of patients with AJCC stages IB and II conducted between April 2015 and December 2016. All patients were followed up prospectively to assess their risk of relapse. Prognostic performance of this test was evaluated individually and later combined with the AJCC staging system. Prognostic accuracy of disease-free survival was determined using Kaplan-Meier curves and Cox regression analysis. Results of the gene expression profile test were designated as Class 1 (low risk) and Class 2 (high risk). RESULTS: Median follow-up time was 26 months (IQR 22-30). The gene expression profile test was performed with 86 patients; seven had developed metastasis (8.1%) and all of them were in the Class 2 group, representing 21.2% of this group. Gene expression profile was an independent prognostic factor for relapse as indicated by multivariate Cox regression analysis, adjusted for AJCC stages and age. CONCLUSIONS: This prospective multicentre cohort study, performed in a Spanish Caucasian cohort, shows that this 31-gene expression profile test could correctly identify patients at early AJCC stages who are at greater risk of relapse. We believe that gene expression profile in combination with the AJCC staging system could well improve the detection of patients who need intensive surveillance and optimize follow-up strategies.

Microscopia confocal de reflectancia: una herramienta útil para diagnosticar malignidad en lesiones melanocíticas que presenten el signo de la isla / Reflectance Confocal Microscopy: A Promising Tool to Identify Malignancy in Melanocytic Lesions Exhibiting a Dermoscopic Island

El signo de la isla se define como un área bien delimitada en una lesión melanocítica, con un patrón dermatoscópico diferente al resto de la lesión. Es predictor de melanoma sobre todo cuando el patrón dermatoscópico de la isla es atípico. Presentamos las características con microscopia confocal de reflectancia (MCR) en un melanoma sobre nevus, un nevus melanocítico y un melanoma in situ con signo de la isla. El melanoma sobre nevus y el melanoma in situ, presentaban atipia celular (células atípicas aisladas y formando nidos) y distorsión arquitectural por MCR. El nevus presentaba un signo de la isla con un patrón globular típico con nidos densos sin atipia por MCR. El signo de la isla se relaciona sobre todo con melanomas in situ y melanomas sobre nevus. El MCR ofrece una buena resolución celular hasta dermis reticular, siendo útil en el diagnóstico de los melanomas con signo de la isla

The dermoscopic island is described as a well-defined area in a melanocytic lesion, with a different dermoscopic pattern from the rest of the lesion. It is predictive of melanoma, particularly when the pattern of the island is atypical. We present the reflectance confocal microscopy (RCM) findings in 3 lesions with dermoscopic islands: nevus-associated melanoma, melanocytic nevus, and in situ melanoma. The nevus-associated melanoma and in situ melanoma presented cellular atypia (atypical cells in isolation or forming nests) and architectural distortion on RCM. The nevus presented a dermoscopic island with a typical globular pattern with dense nests and no atypia on RCM. Dermoscopic island is mainly associated with in situ and nevus-associated melanomas. RCM offers good cellular resolution to the depth of the reticular dermis and is useful for diagnosing of melanomas presenting a dermoscopic island

Reflectance Confocal Microscopy: A Promising Tool to Identify Malignancy in Melanocytic Lesions Exhibiting a Dermoscopic Island. / Microscopia confocal de reflectancia: una herramienta útil para diagnosticar malignidad en lesiones melanocíticas que presenten el signo de la isla.

The dermoscopic island is described as a well-defined area in a melanocytic lesion, with a different dermoscopic pattern from the rest of the lesion. It is predictive of melanoma, particularly when the pattern of the island is atypical. We present the reflectance confocal microscopy (RCM) findings in 3 lesions with dermoscopic islands: nevus-associated melanoma, melanocytic nevus, and in situ melanoma. The nevus-associated melanoma and in situ melanoma presented cellular atypia (atypical cells in isolation or forming nests) and architectural distortion on RCM. The nevus presented a dermoscopic island with a typical globular pattern with dense nests and no atypia on RCM. Dermoscopic island is mainly associated with in situ and nevus-associated melanomas. RCM offers good cellular resolution to the depth of the reticular dermis and is useful for diagnosing of melanomas presenting a dermoscopic island.

Lesión nodular erosiva en el pabellón auricular de una adolescente / Erosive Nodular Lesion in the Auricle of a Teenager's Ear

No disponible

Tumores de colisión valorados por microscopía confocal / Evaluation of Collision Tumors by Confocal Microscopy

No disponible

Carcinoma epidermoide cutáneo de alto riesgo / High-Risk Cutaneous Squamous Cell Carcinoma

El carcinoma epidermoide cutáneo (CEC) es la segunda neoplasia cutánea más frecuente y su incidencia está aumentando en las últimas décadas. La mayoría de los tumores se van a resolver con cirugía, pero alrededor de un 5% van a presentar metástasis locales y a distancia; esta proporción será mayor en algunos CEC que presenten determinados factores denominados de alto riesgo: tamaño tumoral (mayor de 2cm), profundidad de invasión (superior a 2mm), nivel de Clark (IV o superior), invasión perineural, invasión linfovascular, el grado de diferenciación (tumores pobremente diferenciados), tipo histológico (desmoplásico, adenoescamoso, enfermedad de Bowen invasiva o el CEC que aparece sobre un proceso inflamatorio crónico), inmunosupresión, infección por el virus del papiloma humano (VPH), localización en zonas de alto riesgo (pabellón auricular, mucosa labial), expresión de ciertos genes tumorales, o una inadecuada resección del tumor. La séptima y última clasificación TNM de la American Joint Committe on Cancer (AJCC) ha incluido algunos de estos factores de riesgo obteniendo de esta forma un mejor estadiaje. Realizamos una revisión de todos los factores de mal pronóstico del CEC y analizamos la nueva clasificación de la AJCC, así como las opciones terapéuticas del CEC de alto riesgo (AU)

Cutaneous squamous cell carcinoma (cSCC) is the second most common form of skin cancer and its incidence has increased in recent decades. Most cSCCs are successfully treated by surgery, but local and distant metastases develop in approximately 5% of cases; this proportion is higher in certain forms of cSCC with high-risk factors, namely: tumor size >2cm, depth >2mm, Clark level >IV, perineural invasion, lymphovascular invasion, poor differentiation, certain histologic subtypes (desmoplastic or adenosquamous carcinoma, invasive Bowen disease, or a cSCC arising in areas of chronic inflammation), immunosuppression, human papillomavirus infection, high-risk anatomic location (pinna of the ear, labial mucosa), expression of certain tumor genes, and inadequate tumor resection. The latest TNM (tumor, lymph node, metastasis) classification of cSCC published by the American Joint Committee on Cancer (AJCC) in the seventh edition of its Cancer Staging Manual now incorporates several of these risk factors to improve disease staging. We review all the factors currently considered to be markers of poor prognosis in cSCC and analyze the new AJCC classification and the different treatment options for high-risk cSCC (AU)