Risk factors for the development of a second melanoma in patients with cutaneous melanoma.

BACKGROUND: Cutaneous melanoma patients have an increased risk of developing other neoplasms, especially cutaneous neoplasms and other melanomas. Identifying factors associated with an increased risk might be useful in the development of melanoma guidelines. OBJECTIVES: To identify risk factors related to the development of a second primary melanoma in a series of patients diagnosed with sporadic melanoma and to establish the estimated incidence rate. METHODS: A longitudinal study based on prospective follow-up information of patients diagnosed with sporadic cutaneous melanoma at our centre from 2000 to 2015 was performed. Cumulative incidence was estimated based on competing risk models, and the association of characteristics with the risk of a second melanoma was performed by Cox proportional hazard models. RESULTS: Out of 1447 patients included in the study, after a median follow-up of 61 months, 55 patients (3.8%) developed a second melanoma. Fair hair colour, more than 100 common melanocytic nevi and the presence of more than 50 cherry angiomas were independently associated with the development of a second melanoma. The site and the histological subtype of the first and second melanomas were not consistent. The second melanomas were thinner than the first ones. CONCLUSIONS: Fair-haired and multiple-nevi patients might benefit from more intensive prevention measures. The finding of cherry angiomas as a risk factor suggests that these lesions could be markers of skin sun damage in the setting of certain degree of genetic susceptibility.

Efectos inmediatos de la manipulación occipito-atlo-axoidea en el apoyo podal: estudio baropodométrico / Immediate effects of occipito-atloaxoid manipulation on foot support: baropodometric study

Introducción: El equilibrio postural es mantenido gracias a un sistema de aferencias y eferencias en continua adaptación. El objetivo de estas adaptaciones es el mantenimiento de la horizontalidad de la mirada y los centros laberínticos. Para esto el raquis cervical superior tiene un rol importante asegurando la orientación de la cabeza en el espacio. Este estudio trata de evaluar el efecto sobre el apoyo de la normalización propioceptiva del raquis suboccipital. Objetivos: Evaluar cambios inmediatos en la distribución de presiones en el apoyo plantar tras la técnica de thrust occipitoatlo-axoidea (TOAA). Material y Métodos: Se realizó un estudio experimental controlado aleatorizado (ECCA) de carácter explicativo, simple ciego con estrategia de evaluador cegado. Se evaluó a cada sujeto antes y después de la intervención o placebo mediante plataforma de presión. Los sujetos fueron evaluados sin calzado y recibiendo órdenes protocolizadas. La muestra fue de 46 sujetos (25 hombres / 22 mujeres) con una edad media de 24,98±3,04 años. Se utilizó para la comparación intergrupal de la varianza el estadístico ANOVA para las variables paramétricas y la prueba U de Mann Whitney para las no paramétricas. Resultados: Se observó aumento de la «presión máxima» (p=0,044) y del «Porcentaje de carga sobre el pie izquierdo» (p=0,048) acercándolo al reparto equitativo bilateral. Conclusiones: La manipulación occipito-atlo-axoidea aumenta la presión máxima de apoyo y aproxima el porcentaje de carga al reparto equitativo bilateral en sujetos sanos. Los resultados inducen a pensar de cambios en el apoyo tras la técnica, lo cual debe ser comprobado en estudios posteriores con muestras más amplias (AU)

Introduction: Postural balance is maintained thanks to a continually changing system of inputs and outputs. The goal of these changes is to maintain the sight and labyrinthine centres horizontal. To do this, the upper cervical spine has an important role, ensuring the head’s direction within the area. This study is about assessing the effect on the support of proprioceptive normalisation of the suboccipital spine. Objectives: To assess immediate changes in pressure distribution on the arch support after occipito-atlo-axoid thrust (OAAT). Material and methods: A single blind randomised controlled trial (RCT) of an experimental explanatory nature was carried out using the strategy of a blind (no connection between the assessor and inspector) assessor. Each subject was assessed before and after the procedure or placebo using a pressure platform. The subjects were assessed without footwear receiving standardised orders. The sample had 46 subjects (25 men and 22 women) with an average age of 24.98±3.04. For comparison between groups of the variance for parametric variables, the ANOVA statistic was used and for the non-parametric variables the Mann Whitney U test was used. Results: An increase was seen in the «maximum pressure» (p=0.044) and in the «load percentage on the left foot» (p=0.048) coming close to equitable bilateral distribution. Conclusions: Occipito-atlo-axoid manipulation increases the maximum support pressure and approaches the percentage for equitable bilateral load distribution in healthy subjects. The results could lead to considering changes in support after the technique, which must be verified in later studies with larger samples (AU)