How Wide Should the Excision Margins for Facial Small Aggressive Basal Cell Carcinoma Be? Experience With 306 Cases.

BACKGROUND: Subclinical extension (SCE) of basal cell carcinomas (BCCs) may be responsible for incomplete resection of the tumor. The aggressive histological patterns (micronodular, infiltrative, and morpheaform) have greater tendencies toward invading surrounding tissues in an irregular pattern. OBJECTIVE: To determine the SCE of small facial aggressive BCCs excised using Mohs micrographic surgery (MMS). MATERIALS AND METHODS: An observational case series study. Data of patients with facial BCCs with aggressive histological patterns, less than or equal to 6 mm in diameter in high risk site (H zone), and 10 mm in intermediate risk site (M zone), treated with MMS between January 2008 and December 2016, were included. RESULTS: This study included 306 histologically confirmed lesions retrieved from 1,196 clinical records reviewed. Median size of tumors was 5.7 mm (interquartile range: 5-6 mm). Resection of the tumors using 2, 3, and 4 mm margins achieves complete excision of the lesion including the subclinical extension area in 73.9%, 94.4%, and 99% of cases, respectively. CONCLUSION: The present study demonstrated that a 4-mm resection margin was enough to eradicate the lesion completely in 99% of cases of primary small facial BCCs with aggressive histological patterns.

Refractory Bullous Pemphigoid in a Patient with Metastatic Lung Adenocarcinoma Treated with Pembrolizumab.

We present the case of a 73-year-old male patient with a history of tobacco use who presented with a central nervous system mass that was confirmed to be a lung adenocarcinoma metastasis. High PD-L1 expression as well as negativity to other targetable drivers led to initiation of pembrolizumab monotherapy and ablative stereotactic radiation therapy on oligo-residual disease, achieving a complete response after 2 years of therapy. Following discontinuation of systemic treatment, the patient developed widespread desquamative plaques. A skin biopsy revealed subepidermal blistering and eosinophilic infiltration in conjunction with C3 and IgG depositions on the basement membrane, detected by immunofluorescence. A diagnosis of bullous pemphigoid was obtained, and systemic corticosteroids were administered with lesion progression. Infliximab was also administered without meaningful clinical improvement. Metronomic cyclophosphamide achieved a complete resolution of skin lesions and up to this day the patient continues with tumor control and is free of dermatological findings. In conclusion, bullous pemphigoid is a very rare dermatological adverse effect related with pembrolizumab treatment. Only two cases, including this one, have been reported, especially with this medication for the treatment of non-small cell lung cancer. With more reported cases, management strategies can be optimized even in the steroid refractory setting.

Cancer as a Chronic Illness in Colombia: A Normative Consensus Approach to Improving Healthcare Services for those Living with and beyond Cancer and Its Treatment.

Cancer survivorship care in Colombia is of increasing importance. International survivorship initiatives and studies show that continuing symptoms, psychological distress, and late effects impact the quality of life for survivors. Priorities for quality survivorship according to Colombian patients and clinicians are unknown. We undertook a nominal consensus approach with 24 participants using virtual meeting technology to identify the priorities for cancer survivorship. We applied an iterative approach conducted over eight weeks with five workshops and one patient focus group followed by a priority setting survey. The consensus group established six main themes, which were subsequently evaluated by experts: (i) symptoms and secondary effects of cancer; (ii) care coordination to increase patient access and integration of cancer care; (iii) psychosocial support after cancer treatment; (iv) mapping information resources and available support services for long-term cancer care; (v) identifying socioeconomic and regional inequalities in cancer survival to improve care and outcomes; and (vi) health promotion and encouraging lifestyle change. The order of priorities differed between clinicians and patients: patients mentioned psychosocial support as the number one priority, and clinicians prioritized symptoms and surveillance for cancer recurrence. Developing survivorship care needs consideration of both views, including barriers such as access to services and socioeconomic disparities.

Atypical Skin Manifestations During Immune Checkpoint Blockage in Coronavirus Disease 2019-Infected Patients With Lung Cancer.

A new coronavirus, named severe acute respiratory syndrome-coronavirus-2 by the WHO, has rapidly spread around the world since its first reported case in late December of 2019 from Wuhan, the People's Republic of China. As of mid-April 2020, this virus has affected more than 180 countries and territories, infecting more than 1,650,000 individuals and causing over 100,000 deaths. With approximately 20 million new cases globally per year, cancer affects a substantial portion of the population. Individuals affected by cancer are more susceptible to infections owing to coexisting chronic diseases (cardiovascular, pulmonary, and diabetes), overall poor health status, and systemic immunosuppressive states caused by both cancer and the anticancer treatment. As a consequence, patients with malignancies, especially those with lung cancer who develop coronavirus disease 2019, experience more difficult outcomes. A recent multicenter study carried out by the Hubei Anti-Cancer Association has also documented that patients with lung cancer had an increased risk of death, intensive care unit requirement, risk of presenting severe or critical symptoms, and use of invasive mechanical ventilation. Here, we present two representative cases of patients with lung cancer and coronavirus disease 2019 without respiratory compromise and with atypical and severe skin manifestations-findings that could be influenced by the long-term use of anti-programmed cell death protein 1 antibody.

Anti-thyroid and antifungal activities, BSA interaction and acid phosphatase inhibition of methimazole copper(II) complexes.

It has been reported that various metal coordination compounds have improved some biological properties. A high activity of acid phosphatase (AcP) is associated to several diseases (osteoporosis, Alzheimer's, prostate cancer, among others) and makes it a target for the development of new potential inhibitors. Anti-thyroid agents have disadvantageous side effects and the scarcity of medicines in this area motivated many researchers to synthesize new ones. Several copper(II) complexes have shown antifungal activities. In this work we presented for a first time the inhibition of AcP and the anti-thyroid activity produced by methimazole-Cu(II) complexes. Cu-Met ([Cu(MeimzH)2(H2O)2](NO3)2·H2O) produces a weak inhibition action while Cu-Met-phen ([Cu(MeimzH)2(phen)(H2O)2]Cl2) shows a strong inhibition effect (IC50 = 300 µM) being more effective than the reported behavior of vanadium complexes. Cu-Met-phen also presented a fairly good anti-thyroid activity with a formation constant value, Kc=1.02 × 10(10)M(-1) being 10(6) times more active than methimazole (Kc = 4.16 × 10(4)M(-1)) in opposition to Cu-Met which presented activity (Kc=9.54 × 10(3)M(-1)) but in a lesser extent than that of the free ligand. None of the complexes show antifungal activity except Cu-phen (MIC = 11.71 µgmL(-1) on Candidaalbicans) which was tested for comparison. Besides, albumin interaction experiments denoted high affinity toward the complexes and the calculated binding constants indicate reversible binding to the protein.

Colgajo en isla de pedículo miocutáneo bilateral para la reconstrucción de defectos en el dorso nasal y de la punta de la nariz / Myocutaneous bilateral island pedicle flap for nasal tip and supratip reconstruction

La reconstrucción del dorso nasal y de la punta de la nariz, posterior a la resección quirúrgica de lesiones malignas de piel, constituye un gran reto quirúrgico para el cirujano que la enfrenta. Se presenta el caso de una paciente con un defecto posquirúrgico en el dorso nasal, que fue reconstruido con una variante del colgajo en isla. Se describe la técnica quirúrgica empleada y los resultados obtenidos.

Histiocitiosis de células de Langerhans: diez años de experiencia en el Instituto Nacional de Cancerología / Langerhans cell histiocytosis: ten-year experience in The National Institute of Cancer of Colombia

Introducción: La histiocitosis de células de Langerhans, HCL, es un desorden raro caracterizado por la proliferación anormal de un clon de histiocitos que corresponden a células de Langerhans. La enfermedad presenta manifestaciones clínicas muy variadas. En pacientes latinos la entidad ha sido poco descrita. Métodos: Estudio retrospectivo descriptivo tipo serie de casos en un periodo de diez años (enero de 1988 a diciembre de 1999) en el cual se describen las características clínicas, la distribución de la enfermedad y la evolución de 34 pacientes con HCL, con especial interés en las manifestaciones dermatológicas. Resultados: El rango de edad varió de cuatro meses a 47 años con una mediana de tres años. El compromiso multisistémico fue documentado en 16 (47%) pacientes. La lesión dermatológica más frecuente fue la erupción papular en ocho (23.5%) pacientes. Durante un periodo de seguimiento promedio de 3.48 años 7 (20.5%) pacientes murieron. Los casos con enfermedad localizada o limitada a la piel fueron tratados con corticoides tópicos, radioterapia, criocirugía o corticoides orales, mientras que la mayoría de los casos con compromiso multisistémico o enfermedad diseminada fueron tratados con prednisilona y vinblastina o etoposido. Conclusión: La evolución general de esta serie de pacientes con HCL es similar a la reportada en otras series de mayor tamaño en otras partes del mundo.

Léntigo maligno: clínica, histopatología y tratamiento: [revisión] / Lentigo maligna: clinical - histopathological features and treatment: [review]

El léntigo maligno es un melanoma in situ y representa la lesión precursora del léntigo maligno melanoma, la forma invasora de este tumor. El léntigo maligno tiene unas características especiales que lo diferencian de las otras variantes del melanoma in situ, tanto en su presentación clínica como en su apariencia histológica y en su comportamiento biológico. El conocimiento de cada uno de estos aspectos de la biología tumoral permite al médico tratante la elección de la mejor alternativa terapéutica en cada caso.

Tumor pilar proliferante en la espalda: reporte de un caso / Proliferating pilar tumor in the back: case report

Los tumores pilares proliferantes son neoplasias raras generalmente localizadas en el cuero cabelludo que exhiben características de quistes pilares pero presentan una proliferación epitelial extensa con atipia citológica variable y actividad mitótica. Los tumores pilares proliferantes son usualmente benignos aunque caracterizados por frecuentes recurrencias locales. Sin embargo existen reportes de tumores proliferantes malignos. Presentamos el caso de una mujer con diagnóstico de tumor pilar proliferante de localización inusual.

Enfermedad de Paget extramamaria múltiple / Extramammary múltiple Paget’s disease

La enfermedad de Paget es un adenocarcinoma intraepidérmico que se presenta en el complejo areola-pezón o en su forma extramamaria en áreas como la región anogenital, perineal y axilar. Presentamos el caso de un paciente con una enfermedad de Paget extramamaria múltiple del escroto, y las axilas en forma bilateral y la discusión de la literatura de esta rara enfermedad.

Reacciones adversas cutaneas durante la terapia con medicamentos antirreumaticos / Cutaneus adverse effect to antirheumatic drugs

Presentamos en este artículo las reacciones adversas cutáneas que se presentan con más frecuencia durante el tratamiento antirreumático que usamos a diario quienes trabajamos con pacientes reumáticos y que debemos conocer para diagnosticarlas y tratarlas tempranamente