Cutaneous Malignant Melanoma in Chile: Differences in Tumor Thickness and Overall Survival Between Patients From Public and Private Health Care Centers.

INTRODUCTION: A low socioeconomic status (SES) is associated with lower survival rates in cutaneous malignant melanoma (CMM). In South America, there are few studies that analyze CMM data according to SES. OBJECTIVES: To determine the differences in microstaging and overall survival in CMM between public and private health care centers. METHODS: Retrospective cohort study. Histopathological reports with a diagnosis of CMM from two public hospitals (PuH) and one private health care center (PrH) in Santiago from 2008 to 2018 were included. Patients' death certificates were obtained to estimate overall survival. RESULTS: 1014 MMC were found. The mean age was 58.6 ± 16.8 years and 59.9% corresponded to female patients. Of these, 33.9% received treatment at PuH and 66.1% at PrH. Patients from PuH had an increased risk of having an invasive CMM and a >1 mm thickness melanoma compared to PrH (odds ratio 2.77 and 6.06, respectively). Patients with invasive CMM from the PuH were 6.29-fold more likely to die than a patient from the PrH. CONCLUSIONS: We observed a great disparity in tumor thickness between the socioeconomic status, reflecting a later detection and lower survival rate in PuH. Our results highlight a gap on which National Public Health should focus.

Papulosis fibrosa blanca del cuello: a propósito de un caso / White fibrous papulosis of the neck: about a case

La papulosis fibrosa blanca del cuello es una patología benigna, que se presenta frecuentemente en personas mayores y que se caracteriza por pápulas blanquecinas ubicadas habitualmente en las regiones laterales del cuello. El hallazgo histopatológico distintivo es el incremento de las fibras de colágeno en la dermis papilar. Su etiopatogenia es, hasta ahora, desconocida y su tratamiento es difícil. Dado que corresponde a una patología infrecuente, probablemente subdiagnosticada, es que se decide reportar el caso de una mujer chilena de 77 años.

White fibrous papulosis of the neck is a benign pathology, which usually occurs in old people and is characterized by whitish papules that are frequently located in the lateral regions of the neck. The distinctive histopathological finding is the increase of collagen fibers in the papillary dermis. Its pathophysiology is not currently known and its treatment is difficult. Due to being a rare pathology, probably underdiagnosed, it was decided to report the case of a 77-yearold chilean woman.

Collision Tumor between Trichofolliculoma and Melanocytic Nevus.

Trichofolliculoma (TF) is a hamartomatous hair follicle-related tumor, clinically described as a dome-shaped papule with a central pore crossed by one or more silky white hairs. Histologically, it described as a cystic cavity containing keratinous debris, hair shaft fragments, and numerous hair follicles arising from its linings. Collision or compound tumors are a coexistence of two or more identifiable tumors in the same lesion. We present a case of a 47-year-old man with a lesion on his left cheek clinically characterized as a TF. However, the histopathological study reveals a collision tumor involving a TF and a melanocytic nevus. Collision tumors involving melanocytic nevi and hair follicle-related tumors have been previously reported, such as desmoplastic trichoepithelioma, epidermoid cyst, folliculosebaceous cystic hamartoma, and trichoadenoma.

Tricoblastoma de localización acral, una ubicación infrecuente: reporte de un caso / Acral location trichoblastoma, a location infrequent: report of a case

Tricoblastoma es una neoplasia anexial benigna de la piel, de difícil diagnóstico clínico, por su baja prevalencia y por la ausencia de características clínicas patognomónicas. Por esta razón, es la biopsia la que hace el diagnóstico definitivo, ya que se suele confundir con otras neoplasias anexiales. Se presenta caso clínico de una mujer de 87 años con historia de cinco años de evolución de lesión nodular, sésil y simétrica ubicada en la falange proximal del primer ortejo del pie izquierdo, la cual había presentado un crecimiento progresivo en los últimos seis meses, refiriendo molestias leves con el calzado, sin mayores complicaciones. La biopsia excisional de la lesión, es informada como tricoblastoma. El escaso conocimiento del tricoblastoma lleva a la incorrecta interpretación de su forma clínica, lo que resulta relevante, pues su principal diagnóstico diferencial corresponde al carcinoma basocelular (CBC). Se presenta el caso clínico por lo infrecuente de su localización, lo que indujo a confusión del diagnóstico. No se debe olvidar que el tricoblastoma es una neoplasia anexial benigna, que puede presentarse en cualquier sitio en el que existan folículos pilosebáceos, por lo que hay que considerarlo dentro de los diagnósticos diferenciales de cualquier neoplasia anexial.

Trichoblastoma is a skin benign adnexal neoplasm, clinical diagnosis is difficult because presents a low prevalence, it has not any pathognomonic clinical characteristics and it's often mistaken with other adnexal tumors; so the biopsy makes the definitive diagnosis. We report the case of a woman of 87 years with a history of 5 years of evolution of a nodular, sessile and symmetrical lesion located in the proximal phalanx of the first left toe, which had presented a progressive growth in the last 6 months, she presented mild discomfort with footwear, without major complications. The excisional biopsy of the lesion, was reported as a trichoblastoma. Poor knowledge of trichoblastoma leads to a clinical misinterpretation, which is relevant, because its main differential diagnosis corresponds to basal cell carcinoma (BCC). A case located on an extremely rare location is presented, which led to confusion in clinical diagnosis. You must not forget that trichoblastoma is an adnexal benign tumor, which can occur at any site with pilosebaceous follicles, so we should consider in the differential diagnoses of any skin adnexal neoplasms.

Angioma en penacho / Tufted angioma

El Angioma en Penacho es un raro tumor vascular de la infancia, que comparte características con el hemangioendotelioma kaposiforme, teniendo ambos posibilidad de desarrollar Síndrome de Kasabach-Merrit. Presentamos una paciente portadora de un angioma en penacho desde el nacimiento, que hemos seguido por 13 años: clínicamente, con estudios de imágenes y biopsias. El caso presenta similitudes con la literatura, con algunas interesantes peculiaridades en su evolución. Consideramos que por el comportamiento clínico e histológico, el Angioma en Penacho es parte de la misma enfermedad que el Hemangioendotelioma Kaposiforme.

Tufted angioma is a rare vascular tumor of childhood that shares features with the Kaposiform hemangioendothelioma, having both tumors the possibility of developing Kasabach-Merrit phenomenon. We report the case of a patient with a tufted angioma since birth, which we have followed for 13 years: clinically, with imaging studies and biopsies. The case presents similarities with literature, with some interesting peculiarities in its evolution. We consider that because of the clinical and histological behavior, Tufted angioma is a part of the same disease that Kaposiform hemangioendothelioma.

Malignant melanoma in Chile: different site distribution between private and state patients.

BACKGROUND: The body site location of primary Malignant Melanoma (MM) has been correlated with prognosis and survival. Ethnic, genetics, sun exposure factors are related to the anatomical distribution of MM. Low and high socioeconomic strata in Chile differ in ethnic, genetic and cultural conditions. The purpose of this study was to analyze the anatomical MM distribution in the Chilean population in both strata searching for differences due to their ethno-genetic-cultural differences. Records of 1148 MM, 575 cases from state hospitals (Low Socioeconomic Strata, LSS) and 573 cases from private clinics (High Socioeconomic Strata, HSS) were analyzed by body site. RESULTS: Females from LSS showed a higher number of MM in soles, cheeks, and around the eye area. Females from the HSS showed a higher number of MM in dorsal feet and dorsal hands. Males from LSS showed a higher number of MM in soles, around the eye area, and cheeks. However, males from HSS showed a higher number of MM in the trunk, and in the arms. Acral MM was significantly higher in LSS than in the HSS in both sexes. The Chilean population from the HSS and LSS showed differences in the distribution of MM by site. Furthermore, gender differences in the proportion of MM analyzed by anatomical site are observed in both strata. CONCLUSIONS: Results show evidence that differential genetics factors, sun exposure, or other environmental or cultural factors of both strata may account for these differences.

Subungual schwannoma with clinical, sonographic, and histologic correlation.

We show an unusual presentation of a schwannoma that was located in the ungual bed of the left great toe. The clinical, color Doppler ultrasound imaging, and histologic findings are shown to illustrate the case. This type of neurogenic tumor and the ultrasound presurgical imaging support should be considered when dealing with subungual tumors of the foot.

Pentoxifilina como tratamiento efectivo de la lipoidoproteinosis / Pentoxifylline as an effective treatment of lipoidoproteinosis

La lipoido proteinosis es una enfermedad rara, que ocurre por un defecto en el gen que codifica la proteína de la matriz extracelular 1 (ECM1). Estogenera un aumento del colágeno tipo IV, que resulta en depósitos de material hialino anómalo en la dermis y otros tejidos. Actualmente no hay terapias curativas y los múltiples tratamientos utilizados han tenido resultados variables y efectos adversos relevantes.La pentoxifilina es un fármaco que inhibe al factor de crecimiento transformante beta (TGF-beta) y así, regula la producción de colágeno por los fibroblastos. Se ha empleado con éxito en casos de fibrosis renal, hepática y pulmonar y luego de la radioterapia. Se presenta este caso que constituye la primera comunicación de lipoidoproteinosis tratada con pentoxifilina, en el que se evidenció una mejoría clínica, ecográfica y laringoscópica.

Lipoid proteinosisis a rare disease, causedby a defect in the gene encoding the extracellular matrix protein 1 (ECM1), that leads to an increased of collagen type IV, resulting in abnormal deposits of hyaline material in the dermis and other tissues. Currently, there are no curative therapies; several ones have been used with varied results and adverse effects. Pentoxifylline is a drug with inhibitory effect on TGF-beta, thus regulates collagen production by fibroblasts. It has been successfully used in renal, liver and lung transplant and after radiotherapy fibrosis. We present this case because it is the first report of lipoid proteinosis treated with pentoxifylline; with demonstrated clinical, sonographic and laryngoscopic improvement.

Análisis descriptivo de 561 biopsias con diagnóstico de melanoma entre los años 2006 y 2012 en un laboratorio de dermatopatología de la región metropolitana / Descriptive analysis of 561 biopsies with melanoma diagnosis between 2006 and 2012

Durante las últimas décadas la incidencia de melanoma maligno(MM) ha aumentado en gran parte de los países del mundo. Entre los factores más importantes en el desarrollo de un MM está el fototipo del paciente y la exposición a radiación UV. Nuestro país cuenta con escasa información epidemiológica respecto a MM. En este trabajo se analiza la información disponible en las biopsias de piel con diagnóstico de MM procesadas en un laboratorio de dermatopatología en un periodo de siete años. La muestra contó con 561 biopsias, de los cuales el 60,61 por ciento correspondió a sexo femenino, la edad promedio de la muestra fue 54,14 años. Respecto a la localización de las lesiones, el 34,33 por ciento se encontró en extremidades inferiores, 25,70 por ciento en tronco, 21,68 por ciento en cabeza y cuello y 18,27 por ciento en extremidades superiores. El diagnóstico histológico fue melanoma in situ en el 52,88 por ciento de los pacientes e infiltrante en el 47,12 por ciento. Este último grupo se analizó en base al índice de Breslow, observando que el 32,68 por ciento de los pacientes se encontraba en etapa T1. Este trabajo es un aporte para el desarrollo de mayor información epidemiológica respecto a MM, pero dado que se trata de casos exclusivos del sector privado de salud, no es extrapolable a toda la población. Por esto sería de gran utilidad realizar un estudio similar en pacientes atendidos en hospitales, especialmente para revisar el espesor que tienen los melanomas al momento del diagnóstico.

During the last decades, incidence of malignant melanoma (MM) has raised in most countries of the world. Skin phototype and sun exposure are the most important factors related with the development of MM. In our country the epidemiological information in MM is scarse. In this study we analyze available information of skin biopsies with MM diagnosis processed in a dermatopathology lab in a period of 7 years. We analyzed 561 biopsies, 60,61 percent females, with average age of 54,14 years. The lesions were located on lower extremities in 34,33 percent, 25,70 percent on trunk, 21,68 percent on head and neck and 18,27 percent on upper extremities. The histologic diagnosis was in situ melanoma in the 52,88 percent cases and infiltrative melanoma in 47,12 percent cases. Of this last group 32,68 percent were on T1 stage (Breslow index). This study is contributing to the development of more epidemiological information on MM. Because all the cases belong to private practice, we cannot extrapolate the information to global population. It would be useful to replicate this study on public hospital population, with special attention on MM thickness at the diagnosis.

Malignant melanoma in Chile: different site distribution between private and state patients

BACKGROUND: The body site location of primary Malignant Melanoma (MM) has been correlated with prognosis and survival. Ethnic, genetics, sun exposure factors are related to the anatomical distribution of MM. Low and high socioeconomic strata in Chile differ in ethnic, genetic and cultural conditions. The purpose of this study was to analyze the anatomical MM distribution in the Chilean population in both strata searching for differences due to their ethno-genetic-cultural differences. Records of 1148 MM, 575cases from state hospitals (Low Socioeconomic Strata, LSS) and 573 cases from private clinics (High Socioeconomic Strata, HSS) were analyzed by body site. RESULTS: Females from LSS showed a higher number of MM in soles, cheeks, and around the eye area. Females from the HSS showed a higher number of MM in dorsal feet and dorsal hands. Males from LSS showed a higher number of MM in soles, around the eye area, and cheeks. However, males from HSS showed a higher number of MM in the trunk, and in the arms. Acral MM was significantly higher in LSS than in the HSS in both sexes. The Chilean population from the HSS and LSS showed differences in the distribution of MM by site. Furthermore, gender differences in the proportion of MM analyzed by anatomical site are observed in both strata. CONCLUSIONS: Results show evidence that differential genetics factors, sun exposure, or other environmental or cultural factors of both strata may account for these differences.

No clinical predictors of intraepithelial neoplasia in HIV-positive patients with external condilomata acuminata.

To identify clinical parameters in association with human papilloma virus (HPV) genotypes and histopathology diagnosis in HIV-positive patients with external condylomata acuminata (ECA), 400 Chilean HIV-positive patients were included in the study. Forty-seven patients presented ECA. Clinical parameters and socio demographic data were recorded. Histopathology study and HPV linear array genotyping assay were performed. Intraepithelial neoplasia (IEN) grade 2 or 3 was found in 8.5% of patients, associated to HPV-16. Patients were mainly single, MSM, with history of sexually transmitted disease (STD), multiple sexual partners, receiving antiretroviral therapy and with recurrent lesions. All ECA were mainly perianal, grey or pink colored, exophytic with less than two years evolution. No clinical parameter could predict the development of high grade IEN in HIV patients with ECA. It seems necessary to perform biopsy and genotype all HIV positive patients with ECA.

Activity assessment in morphea using color Doppler ultrasound.

BACKGROUND: Morphea (circumcripted cutaneous scleroderma) can be difficult to assess for lesion activity. Because variable-frequency ultrasound with color Doppler provides details of skin morphology and function, it may help in the categorization of morphea. OBJECTIVE: We sought to evaluate color Doppler ultrasound as a probing tool for assessing activity in morphea lesions. METHODS: Consecutive patients with cutaneous morphea referred by dermatologists were studied with color Doppler ultrasound, and the assessment of lesion activity was compared with histologic findings. Normal skin controls were obtained by performing ultrasound scans of healthy subjects or of unaffected areas of the patients themselves. Measurements included cutaneous layer thickness, relative echogenicity, and blood flow with peak systolic velocity. Ultrasound sensitivity and specificity were determined for each phase of morphea activity and the results correlated with histology. RESULTS: Fifty-one patients had a total of 104 morphea lesions. Of the lesions, 20% were active, 22% were atrophic, and 58% were inactive. Five of the patients had the Parry-Romberg syndrome with ipsilateral parotid gland inflammatory involvement, and one had an asymptomatic but sonographically active morphea lesion. Sensitivity and specificity for ultrasound diagnosis were 100% and 98.8%, respectively. The most accurate sonographic signs of lesion activity were increased subcutaneous tissue echogenicity and increased cutaneous blood flow (sensitivity and specificity 100% and 100% for each one). LIMITATIONS: Ultrasound cannot define lesions less than 0.1-mm deep. CONCLUSIONS: The morphologic and functional data obtained noninvasively and in real time with color Doppler ultrasound provide new insight into the pathogenesis of morphea. The technique represents a useful counterpart to histologic examination for the assessment of lesion activity.

Benign tumors and pseudotumors of the nail: a novel application of sonography.

OBJECTIVE: The purpose of this study was to determine the scope of high-resolution sonography in the detection of benign tumors and pseudotumors of the nail unit. METHODS: We performed a retrospective study of the sonographic findings in 103 consecutive patients with benign tumors and pseudotumors of the nail that were medically derived and confirmed histologically. Statistical analysis (Student t test) was performed comparing clinical and sonographic diagnoses. RESULTS: Common benign tumors and pseudotumors of the nail can be detected on sonography, and they present different sonographic morphologic characteristics. According to origin, the lesions were considered ungual in 73% (n = 75) and periungual in 27% (n = 28) of the cases. Sonography showed their nature (solid or cystic), location, and extension as well as regional blood flow. In 35% of the cases, the use of sonography modified the clinical diagnosis, although the detailed anatomic information provided by sonography was useful in the planning of surgery in all cases. The addition of sonography was significant (P < .001) for the diagnosis of subungual exostosis and granulomas in comparison to clinical diagnosis. CONCLUSIONS: Sonography is a noninvasive imaging method that can reliably detect common benign tumors and pseudotumors of the nail and provide precise data about their characteristics. This imaging modality can support diagnosis and surgery and can allow a better definition and improvement of the cosmetic outcome of the treatment.

Anatomical detection of inflammatory changes associated with plantar warts by ultrasound.

BACKGROUND: Plantar warts are common and pain is one of the main symptoms. The anatomical alterations associated with the primary lesion are unclear. Moreover, an adequate separation between the lesion and the surrounding tissue abnormalities could help to better manage this pathology and enable the provision of comprehensive information to physicians and patients. METHODS: A color Doppler ultrasound examination was performed on 29 recurrent plantar warts and 10 healthy controls. The morphology and extension of the warts and surrounding soft tissue abnormalities are described. The diagnosis of a plantar wart was correlated with a standard histology in all cases. Statistical analysis was performed by the Student t test. RESULTS: On ultrasound, all warts were recognizable, and sonographic signs of soft tissue inflammation were detected that were associated with the warts: in 79% (23/29) of the cases there was an increase in sublesional arterial blood flow in the dermis, 54% (16/29) had a plantar bursitis, and 52% (15/29) had a focal decrease in subcutaneous echogenicity. No signs of inflammation were seen in the unaffected controls. CONCLUSION: Ultrasound can provide detailed anatomical data on warts and their inflammatory changes in the surrounding tissues. This noninvasive imaging technique may help to manage difficult cases.

Sonography of plantar warts: role in diagnosis and treatment.

OBJECTIVE: The purpose of this presentation is to show the sonographic morphologic characteristics of plantar warts and the scope of sonography in the treatment of these lesions. METHODS: We retrospectively reviewed 27 sonographic examinations of the plantar region; 17 corresponded to plantar warts diagnosed by dermatologists in which the diagnoses were medically derived from sonographic examinations after failure of their treatments. The remaining group consisted of 10 healthy individuals. Sonograms were compared with standard histologic findings. RESULTS: The sonographic features of normal plantar skin and plantar warts are described, including the shape, echogenicity, pattern of growth, involvement of skin layers, and blood flow in the lesions. CONCLUSIONS: Sonography may be considered as reliable support for plantar wart diagnosis and may have a role in the evaluation of plantar wart treatment modalities, allowing monitoring of therapeutic responses, especially in recurrent and difficult cases with persistent symptoms such as pain.

Tricoepitelioma desmoplásico múltiple de mejillas: a propósito de un caso / Multiple desmoplastic trichoepithelioma: a case report

El tricoepitelioma es una neoformación benigna diferenciada hacia el folículo piloso. Clínicamente puede presentarse en forma múltiple, solitaria o desmoplásica. Histológicamente plantea algunas dificultades para diferenciarlos del carcinoma basocelular (CSC). Se comunica el caso de una mujer de 28 años de edad y se revisa brevemente la literatura.

Trichoepithelioma is a benign neoformation differentiated from the hair follicle, clinical manifestations can be solitary, multiple or desmoplastic lesions. Histologically, it is not easy to differentiate from basal cell carcinoma. We report the case of a 28-year-old woman, and short review.