[Surgical treatment of relapsing keloid of the pinna by fillet flap]. / Tratamiento quirúrgico del queloide recidivante de pabellón auricular mediante <>.

BACKGROUND AND OBJECTIVES: Keloid scars occur when, compared to normal healing, there is excessive formation of collagen after skin wounds or burns. Different treatments have been tried, though no particular one has been shown to be superior. The objective of this study was to assess the usefulness of the surgical technique originally described as keloid fillet flap in the management of relapsing keloids of the pinna. MATERIAL AND METHODS: The study included 10 patients (8 men, 9 white and 1 black) with a keloid on the retroauricular region or earlobe of more than 1 year duration, who had undergone previous treatment (surgery and topical or injected corticosteroids) without a good outcome or with relapse, and who had not received any treatment in the previous 6 months. RESULTS: Five patients were treated with a fillet flap procedure only, while the other 5, in addition to the procedure, also applied 5% imiquimod cream 5 times a week for 1 to 3 months. In 4 patients, no relapse was observed after the intervention. Two patients had partial flap necrosis, with subsequent partial relapse in one of these. Eighty percent reported the outcome of the procedure as good or excellent. CONCLUSION: We achieved a response rate of 40% in the treatment of relapsing keloid of the pinna by a fillet flap procedure. This may be an alternative within the therapeutic arsenal for the treatment of relapsing keloid of the pinna, given that it does not require extensive resources and the skills needed to perform the procedure can be quickly acquired.

Tratamiento quirúrgico del queloide recidivante de pabellón auricular mediante «colgajo en filete» / Surgical treatment of relapsing keloid of the pinna by fillet flap

Introducción y objetivos: El queloide se caracteriza por la formación excesiva de colágeno respecto a la cicatrización normal y puede aparecer de forma secundaria tras una herida o quemadura cutánea. Para su corrección se han ensayado diversos tratamientos, sin que ninguno haya demostrado su superioridad. El objetivo de este estudio es valorar la utilidad de la técnica quirúrgica originalmente descrita como keloid fillet flap (colgajo «en filete») para el tratamiento de queloides auriculares recidivantes. Material y métodos: Se seleccionaron diez pacientes (ocho varones, nueve de raza blanca, uno de raza negra) con queloide retroauricular o de lóbulo recidivante de más de un año de evolución, que habían recibido tratamiento previo (cirugía y corticoides tópicos o en infiltración) sin resultado o con recidiva, y que no habían recibido ningún tipo de tratamiento en los últimos seis meses. Resultados: Cinco pacientes fueron tratados quirúrgicamente solo con colgajo «en filete» y otros cinco con colgajo e imiquimod crema al 5% cinco veces por semana durante uno a tres meses. En cuatro pacientes no se apreció recidiva tras la intervención. Dos pacientes presentaron necrosis parcial del colgajo, uno de los cuales desarrolló recidiva parcial de la lesión. El 80% calificó el resultado de la intervención como bueno o excelente. Conclusiones: Hemos conseguido un 40% de respuesta en el tratamiento del queloide auricular recidivante mediante la realización de colgajo «en filete». Este puede representar una alternativa dentro del arsenal terapéutico disponible para el tratamiento del queloide auricular recidivante, dado que no necesita de grandes medios y puede realizarse después de un entrenamiento mínimo (AU)

Background and objectives: Keloid scars occur when, compared to normal healing, there is excessive formation of collagen after skin wounds or burns. Different treatments have been tried, though no particular one has been shown to be superior. The objective of this study was to assess the usefulness of the surgical technique originally described as keloid fillet flap in the management of relapsing keloids of the pinna. Material and methods: The study included 10 patients (8 men, 9 white and 1 black) with a keloid on the retroauricular region or earlobe of more than 1 year duration, who had undergone previous treatment (surgery and topical or injected corticosteroids) without a good outcome or with relapse, and who had not received any treatment in the previous 6 months. Results: Five patients were treated with a fillet flap procedure only, while the other 5, in addition to the procedure, also applied 5% imiquimod cream 5 times a week for 1 to 3 months. In 4 patients, no relapse was observed after the intervention. Two patients had partial flap necrosis, with subsequent partial relapse in one of these. Eighty percent reported the outcome of the procedure as good or excellent. Conclusion: We achieved a response rate of 40% in the treatment of relapsing keloid of the pinna by a fillet flap procedure. This may be an alternative within the therapeutic arsenal for the treatment of relapsing keloid of the pinna, given that it does not require extensive resources and the skills needed to perform the procedure can be quickly acquired (AU)

[Experience in the treatment of cutaneous in-transit melanoma metastases and satellitosis with intralesional interleukin-2]. / Experiencia en el tratamiento de satelitosis y metástasis cutáneas en tránsito de melanoma con interleucina 2 intralesional.

INTRODUCTION: Although metastatic melanoma has a poor prognosis, cutaneous metastases represent a special case given their ready accessibility, making it possible for dermatologists to apply local treatment. We report our experience with intralesional treatment with interleukin (IL) 2 in 7 patients with cutaneous metastases from malignant melanoma. MATERIAL AND METHODS: A total of 244 lesions in 7 patients with satellitosis and/or cutaneous metastases from malignant melanoma were treated with intralesional IL-2 twice a week. The maximum dose in each patient ranged from 3 to 18 million units per session, according to the number and size of lesions. RESULTS: Complete or partial remission was achieved in almost all lesions (95.9 % and 3.7 %, respectively).Only 1 lesion (0.4 %) -the largest and located subcutaneously- did not respond to intralesional treatment and required alcoholization and subsequent surgical removal to achieve cure. All partial responses occurred in subcutaneous lesions larger than 2 cm. Treatment was well tolerated with only a few mild side effects (grade 1-2). CONCLUSIONS: IL-2 may be an effective and well-tolerated treatment option in patients with satellitosis and cutaneous metastases from melanoma. Lesions smaller than 2 cm and located in the epidermis or superficial dermis respond better than those larger than 2 cm or located in the subcutaneous cellular tissue. More studies are necessary to establish appropriate doses and regimens.

Experiencia en el tratamiento de satelitosis y metástasis cutáneas en tránsito de melanoma con interleucina 2 intralesional / Experience in the Treatment of Cutaneous In-Transit Melanoma Metastases and Satellitosis with Intralesional Interleukin-2

Introducción. A pesar del mal pronóstico del melanoma metastásico, las metástasis cutáneas constituyen un grupo especial por su fácil accesibilidad que lo hace susceptible al abordaje local por parte del dermatólogo. Describimos nuestra experiencia de tratamiento intralesional con interleucina 2 (IL-2) en 7 pacientes con metástasis cutáneas de melanoma maligno. Material y métodos. Un total de 244 lesiones en 7 pacientes con satelitosis y/o metástasis cutáneas de melanoma maligno han sido tratadas con IL-2 intralesional administrada dos veces a la semana. Las dosis máximas por pacientes variaron entre los 3 y 18 millones de unidades/sesión, en función del número y tamaño de las lesiones. Resultados. Se han obtenido remisiones completas (95,9 %) o parciales (3,7 %) en la gran mayoría de lesiones tratadas, una sola lesión (0,4 %), de localización subcutánea y de mayor tamaño, no respondió al tratamiento intralesional y precisó de alcoholización y posterior extirpación quirúrgica para su resolución. Todas las respuestas parciales se observaron en lesiones de localización subcutánea y mayores de 2 cm. El tratamiento fue bien tolerado, con escasos efectos secundarios de intensidad leve (grado 1-2). Conclusiones. La IL-2 puede ser una buena opción para el tratamiento de pacientes con satelitosis y metástasis cutáneas de melanoma con elevada eficacia y escasos efectos secundarios. Las lesiones menores de 2 cm y localizadas en epidermis o dermis superficial responden mejor que las mayores de 2 cm o localizadas en el tejido celular subcutáneo. Son necesarios más estudios para establecer las dosis y pautas de tratamiento adecuadas (AU)

Introduction. Although metastatic melanoma has a poor prognosis, cutaneous metastases represent a special case given their ready accessibility, making it possible for dermatologists to apply local treatment. We report our experience with intralesional treatment with interleukin (IL) 2 in 7 patients with cutaneous metastases from malignant melanoma. Material and methods. A total of 244 lesions in 7 patients with satellitosis and/or cutaneous metastases from malignant melanoma were treated with intralesional IL-2 twice a week. The maximum dose in each patient ranged from 3 to 18 million units per session, according to the number and size of lesions. Results. Complete or partial remission was achieved in almost all lesions (95.9 % and 3.7 %, respectively). Only 1 lesion (0.4 %)—the largest and located subcutaneously—did not respond to intralesional treatment and required alcoholization and subsequent surgical removal to achieve cure. All partial responses occurred in subcutaneous lesions larger than 2 cm. Treatment was well tolerated with only a few mild side effects (grade 1-2).Conclusions. IL-2 may be an effective and well-tolerated treatment option in patients with satellitosis and cutaneous metastases from melanoma. Lesions smaller than 2 cm and located in the epidermis or superficial dermis respond better than those larger than 2 cm or located in the subcutaneous cellular tissue. More studies are necessary to establish appropriate doses and regimens (AU)