The use of bone wax versus dermal regeneration matrix for the reconstruction of scalp defects.

BACKGROUND: Secondary intention healing is an alternative to consider in large tumors or tumors located in areas of limited skin mobility, such as the scalp. To promote epithelialization, we can use Dermal Regeneration Matrix (DRM) or bone wax. OBJECTIVE: This study aimed to compare the efficacy of DRM and bone wax in secondary intention healing of cutaneous scalp tumors in elderly patients with comorbidities. MATERIALS AND METHODS: The medical records of 18 patients with cutaneous scalp tumor healing by secondary intention from February 2022 to April 2023 were analyzed for demographic variables, tumor and surgical characteristics, time from withdrawal of material to complete epithelialization, and need for subsequent surgical intervention. RESULTS: Bone wax was used in 6 patients and DRM in 12. The mean patient age was 84.3 years, and the mean tumor size was 2.7 cm. There were no significant differences in demographics or postoperative complications between the groups. The median time to complete epithelization was 84.5 (60.2-108.7) days in the bone wax group and 105.0 (91.0-126.0) days in the DRM group, with no significant differences (P = 0.15). CONCLUSIONS: Bone wax is a simple and economical material that can be used for secondary intention healing of scalp tumors in elderly patients with high surgical risk.

Melanoma-specific survival is worse in the elderly: a multicentric cohort study.

We aimed to characterise cutaneous melanoma in the elderly and determine its association with poorer prognosis. We studied a prospective cohort of the melanoma population in Catalonia between 2012 and 2016. We compared young patient group (<75 years old) with elderly patient group (≥75 years old). We included 3009 patients (52.5% women) from 14 centres, with a mean age at diagnosis of 61.1 years. In the ≥75-year-old group there was a predominance of men (53.9% vs. 45.5%, P  < 0.001), melanoma was more frequently located in the head and neck area (37.7% vs. 15.5%, P  < 0.001) and lentigo maligna melanoma subtype was significantly more frequent (31.4% vs. 11.6%, P  < 0.001), as were nodular melanoma and acral lentiginous melanoma ( P  < 0.001). In older people, Breslow index, the presence of ulceration and mitotic rate were higher than in younger people. Kaplan-Meier survival curves showed longer melanoma-specific survival (MSS) and melanoma-free survival (MFS) in <75-year-old group compared to the elderly group. Cox regression models demonstrated reduced MSS in patients ≥75 years regardless of gender, location, IB, ulceration and lymph node status at diagnosis (HR 1.54, P  = 0.013) whereas MFS was not independently associated with elderly when head and neck location was considered. Age appears to be an independent risk factor for MSS but not for MFS. Worse melanoma prognosis in elderly could be explained by factors unrelated to the tumour, such as age-related frailty and comorbidities that limit the access to systemic treatments and, eventually, age-related immune dysfunction.

Incidence of Melanoma in Catalonia, Spain, Is Rapidly Increasing in the Elderly Population. A Multicentric Cohort Study.

The incidence of melanoma has been increasing worldwide during recent decades. The objective of the study was to analyse the trends in incidence for in situ and invasive melanoma in the Spanish region of Catalonia during the period of 2008-2017. We designed a cross-sectional study with an age-period-cohort analysis of melanoma patient data from the Network of Melanoma Centres in Catalonia. Our database covered a population of over seven million and included a total of 8626 patients with incident melanoma. The main outcome measures were crude and age-standardised incidence rates to the European 2013 standard population. Joinpoint regression models were used to evaluate the population trends. We observed an increase in the age-standardised incidence rate (per 100,000 population) of all melanoma subtypes from 11.56 in 2008 to 13.78 in 2017 with an average annual percent change (AAPC) of 3.5%. This incidence increase was seen exclusively in the older population. Moreover, the stratified analysis showed a statistically significant increase in the age-standardised incidence rate for invasive (AAPC 2.1%) and in situ melanoma (AAPC 6.5%). In conclusion, the incidence of melanoma has continued to increase in the elderly population over recent decades, with a rapidly increasing trend of in situ melanomas and the lentigo maligna subtype.

Increasing incidence of lentigo maligna and lentigo maligna melanoma in Catalonia.

BACKGROUND: Recent epidemiological studies suggest that past data where superficial spreading melanoma was by far the most common subtype of melanoma may not reflect current patterns of sun exposure or other risk factors more involved in other subtypes of melanoma as lentigo maligna (LM) or lentigo maligna melanoma (LMM). METHODS: In order to measure the current situation in our country, all cases of LM and LMM diagnosed in 23 hospitals in Catalonia, from 2000 to 2007, were recorded. RESULTS: Although for the global period LM/LMM represented only 8.4% of cases, an increasing trend in this percentage was observed throughout the study period (from 6.9% [27 cases] in 2000 to 13.1% [94 cases] in 2007). Also, an increasing incidence of LM/LMM was observed, especially in chronically sun-exposed areas (85.5% involving the head and neck region). During the 8 years of the registry, the mean Breslow thickness of LMM remained stable. However, the increase in the number of LM (in situ) cases was significantly higher than the increase of the invasive ones. CONCLUSIONS: An important observation from this data is that aging of population and current sun exposure patterns could keep increasing the incidence of LM/LMM, which may become an important public healthcare problem, over the other histological subtypes. In order to establish primary or secondary preventive measures to the LM/LMM risk-population, it is imperative to highlight the importance of chronic sun damage as a melanoma risk factor, and not only sunburn, most commonly addressed in melanoma prevention campaigns.

Melanoma incidence increases in the elderly of Catalonia but not in the younger population: effect of prevention or consequence of immigration?

All cases of MM diagnosed in 23 hospitals in Catalonia, from 2000 to 2007 were recorded and melanoma incidence calculated and adjusted for the European standard population via the direct method. The age standardised rate/100,000 inhabitants varied from 6.74 in 2000 to 8.64 in 2007 for all melanomas and from 4.79 to 5.80 for invasive MMs; the Breslow thickness was stable during the period. The increase in invasive melanoma incidence in the elderly was remarkable, the crude rate/100,000 inhabitants increasing from 11.04 (2000) to 15.49 (2007) in the 60-64 year population, while remaining more stable in the 30-34 year range, from 3.97 in 2000 to 4.55 in 2007, and with a tendency to decrease from 5.1 in 2000 to 2.5 in 2007 for the age range of 25-29 years. These lower age ranges are much more affected by immigration. Despite the large immigrant population (nearly one million immigrants arrived in Catalonia during the study period from countries with a low melanoma incidence), melanoma incidence in our region has risen considerably and this trend is likely to persist in the near future.

Localized xanthomas associated with primary lymphedema.

Cutaneous xanthomas arising in chronic lymphedema are rare. We present a case of verruciform xanthoma involving the left foot and toes of a 10-year-old boy who had developed a primary lymphedema (lymphedema praecox) in the left lower extremity. Laboratory studies demonstrated a normal lipid profile.

Multicentric reticulohistiocytosis-mimicking dermatomyositis. Case report and review of the literature.

Multicentric reticulohistiocytosis is a rare disorder of unknown etiology, characterized by skin and mucosal papulonodular eruptions and destructive polyarthritis. Histopathological study of these lesions shows a nodular infiltrate composed of histiocytes and multinucleated giant cells, with an eosinophilic, granular, 'ground-glass' cytoplasm. We report a case of multicentric reticulohistiocytosis with skin lesions mimicking dermatomyositis and we also review previously reported cases describing such a clinical situation. Our case further emphasizes that multicentric reticulohistiocytosis can mimic clinical features of dermatomyositis. A macular or patch-like erythema in a photodistributed fashion, in addition to other clinical manifestations, can be mistaken for dermatomyositis. However, skin biopsies from these areas may early differentiate both conditions with different treatment options and morbidity.

Clinical spectrum and histological analysis of 32 cases of specific cutaneous sarcoidosis.

BACKGROUND: Sarcoidosis is a multisystem granulomatous disorder of unknown aetiology in which skin involvement is frequent. OBJECTIVE: To review histological characteristics of biopsies of specific cutaneous lesions of sarcoidosis and their relationship with clinical course. PATIENTS AND METHODS: Biopsies from 32 patients with specific cutaneous sarcoidosis were reviewed. Histological findings and clinical characteristics of these patients were analysed. RESULTS: The initial clinical lesions of the patients were ten infiltrated nodule-plaques, eight papules, four maculopapular eruptions, five scar sarcoidosis, four subcutaneous nodules and one lupus pernio. Sarcoidal granulomas were located at dermis in 31 cases (74%) and at subcutaneous fat in 12 (28%) but only four were subcutaneous exclusively. Perivascular or periannexial distribution of granulomas was observed in eight cases (19%) and they had coalescence in 29 samples. The presence of foreign material was demonstrated in 11 cases (26%). CONCLUSIONS: Clinical spectrum of specific lesions of cutaneous sarcoidosis showed a good correlation with granulomas localization in the biopsies. However, traditional classification of specific cutaneous sarcoidosis is often overlapping. On the other hand, foreign bodies and other atypical histological findings were more common than initially expected.

Granuloma piogénico recurrente con satelitosis / Recurring pyogenic granuloma with satellitosis

El granuloma piogénico es una tumoración vascular benigna de la piel y las mucosas que puede aparecer espontáneamente o tras un traumatismo. Se describe el caso de un varón de 15 años de edad que, tras la exéresis de un granuloma piogénico en la zona clavicular, desarrolló múltiples lesiones alrededor de la lesión primaria. La aparición de satelitosis es un fenómeno poco frecuente (AU)

Afectación cutánea en la crioglobulinemia tipo II. Asociación con la infección por el virus C de la hepatitis / Cutaneous manifestation in cryoglobulinemia type II. Association with hepatitis C virus infection

Introducción: Las crioglobulinas son unas proteínas anormales que precipitan en suero enfriado. Se han publicado muchos casos de crioglobulinemia mixta asociados a la infección crónica del virus de la hepatitis C. En el espectro clínico de las crioglobulinemias mixtas se ha podido comprobar que la púrpura es la manifestación clínica cutánea más frecuente, sobre todo en mujeres. El objetivo de este trabajo es analizar la relación de los pacientes afectados de crioglobulinemia con la presencia de infección por el virus de la hepatitis C (VHC), lesiones cutáneas y la posibilidad de una afectación sistémica. Pacientes y métodos: Se realiza una revisión prospectiva de 62 pacientes con crioglobulinemia mixta (29 mujeres y 33 varones) con edades comprendidas entre 33 y 81 años (media, 60 años) diagnosticados durante el período comprendido entre enero de 1993 y diciembre de 2000. Resultados: La púrpura ha sido la manifestación cutánea más frecuente, en 27 pacientes (43%), siendo ésta más significativa en mujeres. Este grupo de enfermos con púrpura se caracterizan por presentar unos niveles de crioglobulinemia más elevados, una frecuencia mayor de hipocomplementemia y de afectación renal. La crioglobulinemia tipo IgMk presenta con más frecuencia púrpura, afectación renal e hipocomplementemia que la IgGk. El 72% de los pacientes con crioglobulinemia presentaban infección por VHC. No se han observado diferencias en la proporción de pacientes infectados por el VHC. Conclusiones: Nuestros resultados confirman la elevada incidencia de infección por el VHC en pacientes afectados de crioglobulinemia mixta. La púrpura ha sido la manifestación clínica más frecuente se ha relacionado con unos niveles más altos de crioglobulinemia y una mayor frecuencia de hipocomplementemia y afectación renal (AU)

Carcinoma epidermoide sobre lupus vulgar / Squamous cell carcinoma over lupus vulgaris

La tuberculosis cutánea es una infección poco frecuente en España. Su forma clínica de presentación más común es el lupus vulgar. Es conocido que pueden desarrollarse carcinomas epidermoides sobre úlceras y lesiones cutáneas inflamatorias de larga evolución, entre ellas el lupus vulgar, sobre todo si han sido tratados previamente con radioterapia. Se presentan 2 casos de carcinoma epidermoide desarrollado sobre lesiones de lupus vulgar de más de 40 años de evolución, localizadas en la región pectoral en el primer caso y en la cara en el segundo. Ninguno de ellos había recibido ningún tratamiento antes del diagnóstico del carcinoma epidermoide. La prueba de la tuberculina fue fuertemente positiva en ambos casos, pero sólo en uno de ellos pudo aislarse Mycobacterium tuberculosis en el cultivo de las lesiones cutáneas. Cabe destacar que en nuestros casos la radioterapia no ha intervenido como factor inductor en el desarrollo de la neoplasia (AU)

Granuloma anular macular. Estudio de cinco casos / Patch granuloma annulare. Report of five cases

Introducción. El granuloma anular es una dermatosis de gran variabilidad clínica. Una variante de reciente descripción es la denominada macular. Se describen 5 casos de esta entidad y se efectúa una revisión bibliográfica. Pacientes y método. Se incluyeron en el estudio 5 pacientes que desarrollaron lesiones cutáneas compatibles con un granuloma anular de la variedad macular. En todos ellos se realizó una biopsia "en sacabocados" y se revisaron las características epidemiológicas, clínicas y anatomopatológicas. Resultados. Se trataba de 4 mujeres y un varón, con edades comprendidas entre los 58 y 66 años. Todos ellos presentaban lesiones de meses de evolución localizadas en los muslos, excepto en un caso, que presentaba las lesiones en los antebrazos. Se trataba de máculas redondeadas eritematovioláceas o parduscas de 5 a 15 cm de diámetro y sin cambios epidérmicos. Tres pacientes tenían una única lesión y los otros dos, varias de distribución bilateral y simétrica. En el estudio histológico se observó en todos los casos un infiltrado linfohistiocitario intersticial con necrobiosis difusa y depósitos de mucina. Conclusión. El granuloma anular macular se caracteriza, en la clínica, por la aparición de lesiones maculares eritematosas de crecimiento centrífugo. En la microscopia, el infiltrado linfohistiocitario y la necrobiosis se disponen de una forma difusa, siguiendo un patrón intersticial. El diagnóstico de esta variante de granuloma anular es difícil si no existe un alto índice de sospecha por parte del clínico y del patólogo (AU)

Erupción acneiforme a tipo Halogenodermia por Hidantoínas / Acneiform eruption with Phenytoin Halogenoderma expression

Las halogenodermias son dermatosis poco frecuentes que aparecen tras la ingesta o inhalación de sustancias o fármacos que contienen haluros, generalmente, yoduros y bromuros. Describimos un caso de erupción acneiforme a tipo halogenodermia en un paciente que recibía tratamiento anticonvulsionante con fenitoína (AU)