Dos casos de alergia de contacto a octocrileno en niños / Contact Allergy to Octocrylene in Children: A Report of 2 Cases

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Nevus melanocítico congénito subungueal y periungueal / Congenital Subungual and Periungual Melanocytic Nevus

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Factores de riesgo para el desarrollo de metástasis cutáneas locorregionales como forma única de recaída en los pacientes con melanoma / Risk Factors for the Development of Locoregional Cutaneous Metastases as the Sole Form of Recurrence in Patients With Melanoma

Introducción: Las metástasis cutáneas locorregionales (en tránsito y satelitosis) constituyen un evento poco estudiado en la progresión del melanoma, con diferencias patogénicas y pronósticas respecto a otras formas de recaída locorregional. Conocer las variables predictivas de este evento sería de gran utilidad en su prevención, diagnóstico precoz y tratamiento. El objetivo de este trabajo fue evaluar los posibles factores de riesgo asociados a la aparición de metástasis cutáneas locorregionales como primera forma de recaída en la progresión metastásica del melanoma. Material y métodos: Entre 2000 y 2010, los datos de 1.327 pacientes diagnosticados de melanoma en estadios I y II fueron recogidos de forma prospectiva en nuestras consultas. Durante el seguimiento, un total de 112 (8,4%) pacientes sufrió progresión metastásica de su enfermedad. De ellos, 36 pacientes presentaron metástasis cutáneas locorregionales no concurrentes con otras formas de recurrencia. Las características clínicas e histológicas de este subgrupo fueron evaluadas. Resultados: En el análisis univariante, los factores predictivos significativos fueron la edad del paciente, el espesor del tumor primario, la localización, la ulceración, el índice mitósico y el tipo histológico. Después del análisis multivariante, se mantuvieron como factores de riesgo independientes el espesor (razón de riesgo [RR] 5,6 e IC 95%: 2,7-11,5), la localización del tumor primario en miembros inferiores (RR 3,4 e IC 95%: 1,0-11,5), en cabeza/cuello (RR 4,8 e IC 95%: 1,7-13,5) y en zonas acrales (RR 6,7 e IC 95%: 2,2-20,8). Conclusión: Los pacientes con melanomas de más de 2mm de Breslow, localizados en miembros inferiores, cabeza/cuello y zonas acrales tienen un mayor riesgo de padecer metástasis cutáneas locorregionales. Estos datos podrían ser útiles en el diseño de futuras guías para el seguimiento y manejo del melanoma (AU)

Background: While locoregional cutaneous metastases (in transit and satellite) in melanoma have received little attention from researchers to date, they have pathogenic and prognostic features that distinguish them from other forms of locoregional recurrence. Identifying predictors of these metastases would be of great value for their prevention, early diagnosis, and treatment. The aim of this study was to identify the risk factors associated with locoregional cutaneous metastases as the first form of recurrence in the metastatic progression of melanoma. Material and methods: Between 2000 and 2010, we prospectively collected the data of 1327 patients diagnosed with stage I and II melanoma. During follow up, 112 patients (8.4%) developed metastases. Of these, 36 had exclusively locoregional cutaneous metastases. The clinical and histological characteristics of this subgroup were evaluated. Results: In the univariate analysis, significant predictors were patient age, primary tumor thickness, site, ulceration, mitotic index, and histological type. After multivariate analysis, the independent risk factors were tumor thickness (risk ratio [RR] 5.6; 95% CI: 2.7-11.5) and the location of the primary tumor on the lower limbs (RR 3.4; 95% CI: 1.0-11.5), on the head or neck (RR 4.8; 95% IC: 1.7-13.5), or in acral sites (RR 6.7; 95% IC: 2.2-20.8). Conclusion: Patients who have melanomas with a Breslow thickness of more than 2 mm located on the lower limbs, head, neck, or acral sites have a higher risk of developing locoregional cutaneous metastases. These findings could be useful in the design of future guidelines for the monitoring and management of melanoma (AU)

Melanosis pustulosa transitoria del recién nacido / Transient Neonatal Pustular Melanosis

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Risk factors for the development of locoregional cutaneous metastases as the sole form of recurrence in patients with melanoma.

BACKGROUND: While locoregional cutaneous metastases (in transit and satellite) in melanoma have received little attention from researchers to date, they have pathogenic and prognostic features that distinguish them from other forms of locoregional recurrence. Identifying predictors of these metastases would be of great value for their prevention, early diagnosis, and treatment. The aim of this study was to identify the risk factors associated with locoregional cutaneous metastases as the first form of recurrence in the metastatic progression of melanoma. MATERIAL AND METHODS: Between 2000 and 2010, we prospectively collected the data of 1327 patients diagnosed with stage I and II melanoma. During follow up, 112 patients (8.4%) developed metastases. Of these, 36 had exclusively locoregional cutaneous metastases. The clinical and histological characteristics of this subgroup were evaluated. RESULTS: In the univariate analysis, significant predictors were patient age, primary tumor thickness, site, ulceration, mitotic index, and histological type. After multivariate analysis, the independent risk factors were tumor thickness (risk ratio [RR] 5.6; 95% CI: 2.7-11.5) and the location of the primary tumor on the lower limbs (RR 3.4; 95% CI: 1.0-11.5), on the head or neck (RR 4.8; 95% IC: 1.7-13.5), or in acral sites (RR 6.7; 95% IC: 2.2-20.8). CONCLUSION: Patients who have melanomas with a Breslow thickness of more than 2mm located on the lower limbs, head, neck, or acral sites have a higher risk of developing locoregional cutaneous metastases. These findings could be useful in the design of future guidelines for the monitoring and management of melanoma.

Mitotic rate and subcutaneous involvement are prognostic factors for survival after recurrence in patients with only locoregional skin metastasis as the first site of recurrence from cutaneous melanoma.

BACKGROUND: Few reports on literature give detailed figures on prognostic factors of locoregional skin recurrence in cutaneous melanoma. OBJECTIVE: The aim of this study was to evaluate clinical and histological prognostic factors following development of locoregional cutaneous metastasis as the only progression site from melanoma. METHODS: Data from 1327 stage I and II melanoma patients who visited Instituto Valenciano de Oncología and Consorcio Hospital General Universitario de Valencia from 2000 to 2010 were documented in a prospective manner. During follow up, 112 (8.4%) of them developed recurrent disease. A retrospective analysis revealed a subset of 36 patients with locoregional cutaneous metastases as a first event. RESULTS: Significant prognostic factors in the univariate analysis were Breslow thickness, tumor mitotic rate and the presence subcutaneous involvement of the skin metastasis. After multivariate analysis the independent predictive factors for survival after recurrence were tumor mitotic rate (hazard ratio [HR]: 8.6; 95% CI: 1.0-77.2) and subcutaneous involvement of the skin metastasis (HR: 4.3; 95% CI: 1.0-18.5). CONCLUSION: The survival after recurrence of melanoma patients that has relapsed with only locoregional cutaneous metastasis depends on the mitotic rate of the primary tumor and the subcutaneous involvement of the metastasis.

Sarcoma de Kaposi a tipo linfangioma / Lymphangioma-Like Kaposi Sarcoma

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La utilidad del test de Tzanck para confirmar el diagnóstico de herpes cutáneo / Use of the Tzanck test for confirming the diagnosis of cutaneous herpes

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A pilot study of clinical efficacy of imiquimod and cryotherapy for the treatment of basal cell carcinoma with incomplete response to imiquimod.

BACKGROUND: Cryotherapy is a physical procedure whose immunogenic capability enables it to destroy tumour cells, at least partially. Consequently, it can boost the effect of imiquimod. OBJECTIVE: The objective of the present study was to evaluate the efficacy of combining cryotherapy and imiquimod in patients who did not achieve a complete response after treatment of basal cell carcinoma with imiquimod. The study sample comprised 22 patients with 23 basal cell carcinomas. The tumours were treated with liquid nitrogen (one cycle, 20-30 s) before application of imiquimod (five times weekly for 6 weeks). RESULTS: A maintained complete clinical response was observed in 19 of the 23 tumours (83%), a partial response in three and no response in one. One tumour presented signs of persistence/recurrence during follow-up. CONCLUSIONS: Cryotherapy applied to treat imiquimod-refractory basal cell carcinoma seems to sensitize the tumour to the effect of the drug, thus reducing the percentage of patients who need surgery after an incomplete response to imiquimod. Further studies are necessary to confirm these findings.

Inicio cutáneo de un linfoma anaplásico CD 30+ ALK negativo primario sistémico / Skin Involvement as the Presenting Feature of Primary Systemic Anaplastic Lymphoma Kinase-Negative CD30+ Anaplastic Lymphoma

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Tumor mixohialino inflamatorio de las zonas distales de las extremidades / Inflammatory Myxohyaline Tumor of the Distal Extremities

El tumor mixohialino inflamatorio de las áreas distales de las extremidades (TMHIADE) es un sarcoma de bajo grado de malignidad extremadamente infrecuente, con tendencia a la recurrencia local tras su extirpación quirúrgica, pero con un bajo potencial metastásico. Presentamos el caso de una mujer de 49 años que consultó por una tumoración asintomática de lento crecimiento en la zona pretibial derecha, que inicialmente sugirió el diagnóstico de lipoma. El estudio histopatológico mostró la presencia de un infiltrado inflamatorio polimórfico inmerso en una matriz mixoide e hialina. Entremezcladas entre las células inflamatorias existían varias poblaciones de células tumorales: en primer lugar, unas células atípicas de morfología fusiformes; en segundo lugar, unas células epitelioides bizarras, algunas de las cuales eran multinucleadas y recordaban a los virocitos o células de Reed-Sternberg; por último, unas células de citoplasma amplio multivacuolado que recordaban a los lipoblastos. Estos hallazgos clínico-patológicos permitieron el diagnóstico de tumor mixohialino inflamatorio de las áreas distales de las extremidades. A pesar de que la tumoración se extirpó con márgenes quirúrgicos amplios, presentó una recidiva local tres meses después que fue tratada con nueva extirpación quirúrgica y radioterapia (AU)

Inflammatory myxohyaline tumor of the distal extremities is an extremely rare low-grade sarcoma with a tendency to produce local recurrence after surgical excision, but with a low metastatic potential. We present the case of a 49-year-old woman with a slow-growing asymptomatic tumor on the right pretibial region that was initially considered to be a lipoma. Histopathology revealed the presence of a polymorphic inflammatory infiltrate within a myxoid and hyaline matrix. Interspersed between the inflammatory cells were 3 different populations of neoplastic cells: atypical spindle-shaped cells; bizarre epithelioid cells, some of which were multinucleated and resembled the virocytes or Reed-Sternberg cells; and cells with abundant, vacuolated cytoplasm, similar to lipoblasts. These clinical-pathologic findings led to a diagnosis of inflammatory myxohyaline tumor of the distal extremities. Although the tumor was excised with wide surgical margins, local recurrence developed after 3 months and was treated with re-excision and radiotherapy (AU)