Subungual Melanoma: A Descriptive Study of 34 Patients. / Melanoma subungueal: estudio descriptivo de 34 pacientes.

INTRODUCTION AND OBJECTIVES: Subungual melanoma constitutes a diagnostic challenge because it often has an atypical clinical presentation. The aims of this study were to revise the clinical and pathologic characteristics of patients with subungual melanoma diagnosed at a tertiary care university hospital and analyze the factors potentially associated with a delayed diagnosis. MATERIAL AND METHODS: We analyzed data for 34 patients diagnosed with subungual melanoma at our hospital over a period of 20 years. RESULTS: The study population comprised 18 women and 16 men with a median age at diagnosis of 66 years. Only 5 of the patients had longitudinal melanonychia when examined at the dermatology department. At the time of diagnosis, 19 of the 34 patients had invasive melanoma (median Breslow thickness, 3.70mm); 16 had ulceration and 8 had regional lymph node involvement. Five patients had subungual melanoma in situ at diagnosis. The median time from appearance of the lesions to consultation at a primary care center was 15 months; the corresponding time from primary care consultation to diagnosis at our hospital was 5.5 months. Lesions located on the toes were more likely to be ulcerated (P=.017) and to be accompanied by regional lymph node involvement at diagnosis (P=.012). CONCLUSIONS: The factors associated with a longer diagnostic delay in patients with subungual melanoma were absence of melanonychia as a presenting feature and involvement of the toes.

Behavioral Interventions for Preventing Sexually Transmitted Infections and Unintended Pregnancies: An Overview of Systematic Reviews. / Intervenciones conductuales para la prevención de infecciones de transmisión sexual y embarazo no deseado: revisión de revisiones sistemáticas.

BACKGROUND: Countless sex education programs have been implemented worldwide in recent decades, but epidemiological data show no improvement in rates of sexually transmitted infections or unintended pregnancies. OBJECTIVE: To summarize the evidence from higher-quality systematic reviews on the efficacy of behavioral interventions for the prevention of sexually transmitted infections and unintended pregnancies. METHODS: We conducted an overview of reviews by selecting systematic reviews that met minimum quality criteria in terms of the design of the studies reviewed. We compared the results obtained when the effects of interventions were assessed on the basis of objective criteria (biological data) to those obtained when outcomes were assessed on the basis of subjective criteria (self-reports). The results of Cochrane and non-Cochrane reviews were also compared. RESULTS: We identified 55 systematic reviews. No overall effect on the sexual behavior of program participants was observed in 72.5% of the reviews that used objective criteria and in 48.1% of the reviews based on subjective criteria. In the Cochrane reviews, no evidence of an overall effect was observed in 86% of reviews based on objective variables and in 70.5% of those based on subjective variables. CONCLUSIONS: There is no evidence that behavioral interventions modify rates of sexually transmitted infections (including human immunodeficiency virus infections) or unintended pregnancies, particularly when effects are assessed using objective, biological data. Primary prevention strategies for sexually transmitted infections and unintended pregnancies need to be re-evaluated.

Enfermedad de Paget extramamaria / Extramammary Paget's disease

La enfermedad de Paget extramamaria es un carcinoma epidérmico de diferenciación apocrina que se origina en la epidermis o secundario a la diseminación epidermotropa de neoplasias adyacentes o a distancia. Suele presentarse como una lesión eccematiforme, de límites bien definidos, en zonas ricas en glándulas apocrinas como axilas, zona genital y anal. Su pronóstico depende de 2 factores: la profundidad de la invasión del tumor primario y de la presencia o no de tumor asociado. Su sintomatología inespecífica y la lenta evolución de las lesiones a menudo provoca un retraso en el diagnóstico que conlleva un empeoramiento del pronóstico. El diagnóstico de enfermedad de Paget es histológico precisando en ocasiones un estudio inmunohistoquímico. La inmunohistoquímica permite orientar hacia la naturaleza primaria o secundaria de la enfermedad, pero precisará de un estudio de extensión (AU)

Extramammary Paget disease is an epidermal carcinoma with apocrine differentiation originating in the epidermis o secondary to epidermotropic dissemination from a near or distant neoplasm. It usually shows as an eczematiform lesion with well defined margins in areas rich in apocrine glands, such as the axilla, genital and anal areas. Prognosis is defined by two factors: depth of invasion of primary tumour and whether there is an associated tumour. Its non specific clinical signs and slow evolution of the lesions, often delay the diagnosis, which leads to a poor prognosis. The diagnosis of Paget's disease is histological, sometimes requiring an immunohistochemical study. This can orient towards the primary or secondary nature of the disease, but will still need an extension study (AU)

Enfermedad pulmonar y afectación ungueal / Lung disease and nail-bed involvement

El síndrome de las uñas amarillas es una entidad poco frecuente caracterizada por la tríada de uñas amarillas, afectación pleuropulmonar y linfedema primario. Su origen aún no está aclarado pero se sugiere una alteración del retorno linfático como causa de todas sus manifestaciones. Presentamos este caso por la importancia que puede tener diagnosticar este síndrome y descartar posibles procesos patológicos asociados (neoplasias, VIH, tuberculosis, enfermedad tiroidea, artritis reumatoide), ya que es fácil llegar al diagnóstico si se conocen los signos cardinales, sobre todo la típica afectación ungueal (uñas amarillas y detención del crecimiento ungueal). En el tratamiento de este síndrome se han propuesto muchas alternativas, incluido el itraconazol oral, la vitamina E o los suplementos de cinc, pero la baja prevalencia de la enfermedad y la posibilidad de curación espontánea hacen que sea difícil evaluar la verdadera eficacia de las diferentes medidas terapéuticas (AU)

Yellow nails syndrome is a rare disease characterised by a triad of, yellow nails, pleural and lung involvement and primary lymphoedema. Its origin still remains unclear, but lymphatic return disturbance has been suggested as the reason of all its signs. We present this case because of the importance of diagnosing this syndrome and to rule out other associated diseases (malignancies, HIV, tuberculosis, thyroid disease, rheumatoid arthritis) as the diagnosis of the disease is easy if cardinal signs are known, particularly the condition of the nails (yellow nails and halted nail growth). Many possibilities have been proposed on the treatment of this syndrome,including, oral itraconazole, oral vitamin E, and zinc supplements, but the low prevalence of the disease and the possibility of spontaneous healing makes it difficult to evaluate the real effectiveness of the different treatments (AU)