65 results on '"B. Llombart"'
Search Results
2. Cemiplimab in Advanced Cutaneous Squamous Cell Carcinoma: Real-World Experience in a Monographic Oncology Center
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E. Ríos-Viñuela, P. Álvarez, J. Lavernia, C. Serra-Guillén, C. Requena, E. Bernia, A. Diago, B. Llombart, and O. Sanmartín
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General Medicine - Published
- 2022
3. La Presencia De Infiltración Linfovascular Y De Un Alto Número De Mitosis Se Asocian A Un Mayor Riesgo De Recidiva En Sarcoma Pleomórfico Dérmico
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M. Pons Benavent, E. Ríos-Viñuela, E. Nagore, C. Monteagudo, M. Aguerralde, D. Mata Cano, B. Llombart, C. Serra-Guillén, I. Pinazo Canales, C. Requena, and O. Sanmartín
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General Medicine - Published
- 2023
4. Papel de la 18F-FDG PET/TC en el manejo del carcinoma de células de Merkel: experiencia de 51 estudios en nuestra institución
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B. Llombart Cussac and V. López Prior
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Gynecology ,03 medical and health sciences ,medicine.medical_specialty ,0302 clinical medicine ,business.industry ,Medicine ,Radiology, Nuclear Medicine and imaging ,business ,030218 nuclear medicine & medical imaging - Abstract
Resumen Objetivos El carcinoma de celulas de Merkel (CCM) es un raro y agresivo tumor neuroendocrino en el que existe poca evidencia del papel de la 18F-FDG PET/TC. El objetivo del estudio es evaluar el impacto de 18F-FDG PET/TC en el manejo de estos pacientes. Material y metodo Evaluamos retrospectivamente 51 estudios 18F-FDG PET/TC de 35 pacientes (19 hombres [54,30%], de 72,17 ± 14,63 anos) con histologia de CCM. Se analiza el cambio en el estadio (CE) y el impacto en el tratamiento (IT). Resultados Hubo 23 estudios PET/TC positivos (45,10%) y 28 (54,90%) negativos. Treinta y cuatro (66,7%) estudios se realizaron para estadificacion inicial y 17 (33,3%) se hicieron en el seguimiento: 6 (35,29%) por sospecha de recurrencia, 7 (41,18%) para reestadificacion y 4 (23,53%) como parte de la vigilancia posterior. En base a los resultados PET/TC hubo CE en 20 estudios (39,20%) e IT en 28 (54,90%): en la estadificacion inicial CE en 11 (32,40%) e IT en 12 (35,30%); en la reestadificacion CE en 5 (71,43%) e IT en 7 (100%); en la sospecha de recurrencia CE en 3 (50,00%) e IT en 6 (100%); en la vigilancia posterior CE en 1 (25,00%) e IT en 3 (75,00%). La PET/TC incidentalmente detecto un cancer adicional confirmado histologicamente. La presencia de adenopatias clinicas al inicio (0,0098; HR 3,82; IC 95%: 1,38-10,6), el haber recibido tratamiento quimioterapico (6e-04; HR 7,06; IC 95%: 2,30-21,60), un tamano tumoral ˃ 2 cm (0,0116; HR 6,79; IC 95%: 1,53-30,10) y la presencia de margenes positivos (0,00069; HR 4,01; IC 95%: 1,46-11,00) fueron factores pronosticos estadisticamente significativos para la supervivencia global. Se observa una tendencia a peor supervivencia global con una PET/TC positiva al inicio pero sin alcanzar la significacion estadistica. Conclusiones La 18F-FDG PET/TC altero el estadio en 2 de cada 5 estudios y cambio el tratamiento en mas de la mitad de los estudios realizados. El estudio confirma el importante impacto de la 18F-FDG PET/TC en el manejo de los estos pacientes.
- Published
- 2021
5. The role of 18F-FDG PET/CT in the management of Merkel cell carcinoma: The experience of 51 studies in our institution
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B. Llombart Cussac and V. López Prior
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Chemotherapy ,Merkel cell carcinoma ,business.industry ,medicine.medical_treatment ,General Engineering ,Cancer ,medicine.disease ,Primary tumor ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Statistical significance ,medicine ,Resection margin ,General Earth and Planetary Sciences ,Fdg pet ct ,Stage (cooking) ,business ,Nuclear medicine ,General Environmental Science - Abstract
Objectives Merkel cell carcinoma (MCC) is a rare and aggressive neuroendocrine tumor with limited evidence on the role of 18F-FDG PET/CT. The aim of this study was to assess the impact of the 18F-FDG PET/CT in the management of MCC. Methods Fifty-one studies of 18F-FDG PET/CT of 35 patients (19 men [54.30%]; 72.17±14.63years) with histologic diagnosis of MCC were retrospectively evaluated. The change in tumor staging and the impact on the treatment were analysed. Results There were 23 PET/CT positive studies (45.10%) and 28 (54.90%) negative. Thirty four (66.7%) studies were performed for assessment of stage at initial presentation and 17 (33.3%) were performed during the follow up: 6 (35.29%) for suspected recurrence; 7 (41.18%) for restaging; 4 (23.53%) as a part of ongoing surveillance. On the basis of PET/CT results, there was a change in disease stage (SC) in 20 studies (39.20%) and impact in the management (MI) in 28 (54.90%): 11 (32.40%) SC and 12 (35.30%) MI in the initial staging; 5 (71.43%) SC and 7 (100%) MI in the restaging; 3 (50.00%) SC and 6 (100%) MI in suspected recurrence; 1 (25.00%) SC and 3 (75.00%) MI in the surveillance. 18F-FDG PET/CT incidentally detected one additional histologically confirmed cancer. The presence of nodal involvement in the beginning (0.0098; HR 3.82; 95%CI: 1.38-10.6), chemotherapy treatment (6e-04; HR 7.06; 95%CI: 2.30-21.60), size of primary tumor >2cm (6e-04; HR 7.06; 95%CI: 2.30-21.60) and positive resection margin (0.00069; HR 4.01; 95%CI: 1.46-11.00) were statistically significant prognostic factors for overall survival. There was a trend towards significance for worse overall survival with initial positive 18F-FDG PET/CT but the trend did not reach statistical significance. Conclusion 18F-FDG PET/CT altered the stage in 2 out of 5 studies and changed the treatment in more than half of the studies performed. The study confirms the important impact of 18F-FDG PET/CT on the management of MCC patients.
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- 2021
6. Sonidegib en el tratamiento del carcinoma basocelular localmente avanzado
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G. Carretero Hernández, Á. Flórez Menéndez, B. Llombart, S. Puig, Rafael Botella-Estrada, E. Herrera Ceballos, and O. Sanmartín
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Hedgehog pathway inhibitors ,Hedgehog signaling pathway ,RL1-803 ,General Medicine ,Dermatology ,Locally advanced basal cell carcinoma ,Internal medicine ,RC31-1245 ,Sonidegib - Abstract
Resumen: Sonidegib es un inhibidor del receptor transmembrana Smoothened (SMO), de la vía de señalización de Hedgehog, indicado para el tratamiento del carcinoma basocelular localmente avanzado (CBCla), no susceptible a cirugía curativa ni a radioterapia. Sonidegib ha demostrado su eficacia y seguridad en pacientes con CBCla en el ensayo de fase II (BOLT), donde el 61% (IC 95%: 48; 72) de los pacientes tratados con 200 mg de sonidegib tuvo una respuesta objetiva al tratamiento, con un tiempo medio hasta la respuesta de cuatro meses. La mediana de duración de respuesta fue de 26,1 meses y la mediana de supervivencia libre de progresión fue de 22,1 meses. Los eventos adversos más frecuentes fueron los espasmos musculares (54,4%), alopecia (49,4%) y disgeusia (44,3%), siendo principalmente de grado 1 y 2. Esta revisión proporciona un resumen sobre la eficacia, seguridad y tolerabilidad de sonidegib, así como consideraciones sobre su uso en el manejo de pacientes con CBCla. Abstract: Sonidegib is an antagonist of the transmembrane protein Smoothened in the Hedgehog signaling pathway. It is indicated for the treatment of locally advanced basal cell carcinoma (BCC) that is not amenable to curative surgery or radiotherapy. Sonidegib's efficacy and safety were demonstrated in the phase 2 BOLT trial, where 61% (95% CI, 48-72%) of patients with locally advanced BCC treated with sonidegib 200 mg achieved an objective response to treatment with a mean time to response of 4 months. The median duration of response was 26.1 months and the median progression-free survival was 22.1 months. The most common adverse events were muscle spasms (54.4%), hair loss (49.4%), and loss of taste (44.3%); most events were grade 1 or 2. In this review, we summarize the main findings on the efficacy, safety, and tolerability of sonidegib and discuss the management of locally advanced BCC with this drug.
- Published
- 2021
7. Sonidegib in the Treatment of Locally Advanced Basal Cell Carcinoma
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Á. Flórez Menéndez, O. San Martín, B. Llombart, S. Puig, G. Carretero Hernández, Rafael Botella-Estrada, and E. Herrera Ceballos
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Oncology ,medicine.medical_specialty ,Histology ,business.industry ,medicine.medical_treatment ,Antagonist ,Dermatology ,medicine.disease ,Sonidegib ,Pathology and Forensic Medicine ,Radiation therapy ,030207 dermatology & venereal diseases ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Hair loss ,Tolerability ,chemistry ,030220 oncology & carcinogenesis ,Internal medicine ,medicine ,Basal cell carcinoma ,Smoothened ,Adverse effect ,business - Abstract
Sonidegib is an antagonist of the transmembrane protein Smoothened in the Hedgehog signaling pathway. It is indicated for the treatment of locally advanced basal cell carcinoma (BCC) that is not amenable to curative surgery or radiotherapy. Sonidegib's efficacy and safety were demonstrated in the phase 2 BOLT trial, where 61% (95% CI, 48-72%) of patients with locally advanced BCC treated with sonidegib 200 mg achieved an objective response to treatment with a mean time to response of 4 months. The median duration of response was 26.1 months and the median progression-free survival was 22.1 months. The most common adverse events were muscle spasms (54.4%), hair loss (49.4%), and loss of taste (44.3%); most events were grade 1 or 2. In this review, we summarize the main findings on the efficacy, safety, and tolerability of sonidegib and discuss the management of locally advanced BCC with this drug.
- Published
- 2021
8. Oral Contraceptives in Dermatology
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C. Requena and B. Llombart
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medicine.medical_specialty ,Histology ,medicine.drug_class ,media_common.quotation_subject ,Dermatology ,Pathology and Forensic Medicine ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Levonorgestrel ,030212 general & internal medicine ,Ovulation ,hirsutism ,Acne ,media_common ,Skin manifestations ,Pregnancy ,business.industry ,Hyperandrogenism ,medicine.disease ,Estrogen ,030220 oncology & carcinogenesis ,business ,hormones, hormone substitutes, and hormone antagonists ,medicine.drug - Abstract
Oral contraceptives combine estrogen and progesterone to suppress ovulation. Synthetic forms are usually used. In dermatology, oral contraceptives are prescribed for 2 main reasons: to prevent pregnancy when teratogenic drugs must be taken and to treat skin manifestations of hyperandrogenism. Most oral contraceptives improve both acne and hirsutism, but the androgenic effect of progestogens - particularly if the contraceptive contains first- or second-generation progestogens- can trigger or exacerbate acne. One of the most serious side effects of oral contraceptives, thrombosis, is mainly caused by the estrogen component and its dose. If we mainly consider a contraceptive's thrombotic profile when prescribing, the choice would be to have 30μg or less of ethinyl estradiol combined with levonorgestrel. On the other hand, if our main objective is to treat signs of androgenization, we would prefer contraceptives containing progestogens with antiandrogenic effects.
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- 2020
9. Anticonceptivos orales en dermatología
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B. Llombart and C. Requena
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General Medicine - Abstract
Resumen Los anticonceptivos orales son farmacos compuestos por un estrogeno y un progestageno, habitualmente sinteticos, que inhiben la ovulacion. En dermatologia los anticonceptivos orales se emplean con 2 indicaciones principales: para evitar el embarazo cuando empleamos farmacos teratogenos y para tratar manifestaciones cutaneas de hiperandrogenismo. La mayoria de los anticonceptivos orales mejoran tanto el acne como el hirsutismo, sin embargo el empleo exclusivo de progestagenos como anticonceptivos, especialmente de primera o segunda generacion puede agravar o desencadenar un acne, debido a su efecto androgenico. La trombosis es uno de los efectos secundarios mas graves de los anticonceptivos orales y depende sobre todo de los estrogenos empleados y su dosis. Si atendemos solo al perfil trombotico, el anticonceptivo oral de eleccion deberia ser el que combinara 30 o menos μg de etinilestradiol con el levonorgestrel. Por el contrario, si lo que queremos es tratar signos de androgenizacion, los anticonceptivos orales preferidos seran aquellos con progestagenos de efecto antiandrogenico.
- Published
- 2020
10. Functions of Dermatology Residents’ Supervisors
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R.M. Díaz, Pedro Jaén, Vicente García-Patos, S. Medina, and B. Llombart
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medicine.medical_specialty ,Histology ,business.industry ,Family medicine ,medicine ,Dermatology ,business ,Pathology and Forensic Medicine - Published
- 2020
11. Funciones de los tutores de residentes de Dermatología
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R.M. Díaz, S. Medina, B. Llombart, V. García-Patos, and P. Jaén
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General Medicine - Published
- 2020
12. Eritema papular semicircular recidivante: ¿nueva entidad o subtipo de eritema anular centrífugo?
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B. Llombart, C. Requena, and E. Bernia
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General Medicine - Published
- 2020
13. Carcinoma de células de Merkel: diagnóstico y tratamiento en atención especializada dermatológica. Guía de práctica clínica de la Academia Española de Dermatología y Venerología
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M.T. Fernández Figueras, N. Rodríguez Salas, M.A. Descalzo-Gallego, J. Vázquez Doval, Ignacio García-Doval, M.J. Fuente González, A. Pérez Bustillo, Mónica Villanueva, L. Ríos-Buceta, S. Paradela de la Morena, and B. Llombart Cussac
- Subjects
General Medicine - Abstract
Resumen Antecedentes y objetivo El carcinoma de celulas de Merkel es un tipo de cancer de piel infrecuente y agresivo. Hay una gran variacion en su manejo y las diferentes guias extranjeras que existen cubren parcialmente los problemas identificados como principales. El objetivo de la presente guia es servir de referencia a los dermatologos espanoles para mejorar aspectos controvertidos del diagnostico, estadificacion y tratamiento del carcinoma de celulas de Merkel. Materiales y metodos Se empleo el metodo ADAPTE: se escogio a miembros del Grupo Espanol de Dermato-Oncologia y Cirugia (GEDOC) con experiencia en el tratamiento de estos tumores y con interes en participar en la elaboracion de la guia. Tras resumir el proceso de atencion y elaborar las preguntas clinicas relevantes, se hizo una busqueda de guias, que se seleccionaron segun su puntuacion mediante el instrumento Appraisal of Guidelines for Research and Evaluation (AGREE II). Tras la busqueda de las respuestas en dichas guias, se elaboraron posteriormente las recomendaciones. Por ultimo, se sometio la guia a revision externa. Resultados Las guias con mejor puntuacion fueron las de National Comprehensive Cancer Network, la European consensus-based interdisciplinary guideline, Alberta Healthservices Clinical practice guideline, American Cancer Society y Cutaneous Oncology Group of the French Society of Dermatology. Se obtuvieron en total 9 preguntas clinicas, contestadas a partir de estas guias. Conclusiones Esta guia responde a preguntas habituales en la practica clinica diaria y sirve a los dermatologos como referencia en la toma de decisiones, siempre teniendo presentes los recursos y preferencias del paciente.
- Published
- 2019
14. Diagnosis and Treatment of Merkel Cell Carcinoma in Specialized Dermatology Units: A Clinical Practice Guideline of the Spanish Academy of Dermatology and Venereology
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L. Ríos-Buceta, J. Vázquez Doval, S. Paradela de la Morena, M.J. Fuente González, M.T. Fernández Figueras, B. Llombart Cussac, A. Pérez Bustillo, M.A. Descalzo-Gallego, Mónica Villanueva, N. Rodríguez Salas, and Ignacio García-Doval
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medicine.medical_specialty ,Care process ,Histology ,Venereology ,Merkel cell carcinoma ,business.industry ,Cancer ,Dermatology ,Guideline ,medicine.disease ,Pathology and Forensic Medicine ,Clinical Practice ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,medicine ,Skin cancer ,business ,Merkel cell - Abstract
Background and objective Merkel cell carcinoma is a rare, aggressive skin cancer that is managed in a great variety of ways. However, international clinical practice guidelines give only partial coverage to issues considered major problems.The recommendations presented here aim to provide Spanish dermatologists with a guide to improving disputed aspects of diagnosis, staging, and treatment of localized Merkel cell carcinomas. Material and methods The ADAPTE process was used. Members of the Spanish Group of Oncologic Dermatology and Surgery (GEDOC) with experience in treating Merkel cell carcinoma and interest in drafting these guidelines were selected. The group described the care process and listed the most important clinical questions. They then searched for guidelines and assessed them with the AGREE II (Appraisal of Guidelines for Research and Evaluation) tool. After consulting the guidelines for answers to their clinical questions, the group drafted the present statement and sent it for external review. Results The guidelines that scored highest in the AGREE II assessment step were the consensus-based interdisciplinary guideline of the European Association of Dermato-Oncology and the European Organization of Research and Treatment of Cancer, and those of the Comprehensive Cancer Network, the Alberta Health Services in Canada, the American Cancer Society, and the Cutaneous Oncology Group of the French Society of Dermatology. A total of 9 clinical questions were answered based on these guidelines. Conclusions The guidelines presented here answer clinical questions that arise in routine practice. They can provide dermatologists with a starting point for decision-making, although available resources and patient preferences must always be borne in mind.
- Published
- 2019
15. Morfea postradioterapia en pacientes con cáncer de mama. Posible relación con otras enfermedades autoinmunes
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O. Sanmartín, C. Guillén, C. Requena, B. Llombart, and A. Diago
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General Medicine - Abstract
Resumen La morfea postradioterapia es una entidad poco frecuente descrita mayoritariamente en mujeres con cancer de mama. El uso creciente de la radioterapia en el tratamiento del cancer de mama, asi como la similitud clinica de la morfea con otros cuadros tales como la radiodermitis, la fibrosis postradiacion o la recidiva tumoral, obligan al dermatologo al conocimiento de esta entidad. Presentamos una serie de 6 mujeres, con una media de edad de 64,2 anos y un tiempo medio de latencia entre la radioterapia y la morfea de 9,5 anos. Cuatro de las 6 pacientes presentaban algun trastorno de base autoinmune (artritis reumatoide, sindrome de Sjogren, vitiligo y enfermedad de Crohn) entre sus antecedentes. Hasta el momento actual no se han encontrado factores de riesgo que predispongan al desarrollo de morfea tras el tratamiento con radioterapia, si bien parece que presentar algun trastorno de base autoinmune puede condicionar la aparicion de morfea en pacientes tratados con radioterapia.
- Published
- 2019
16. Leiomiosarcoma y sarcoma pleomórfico dérmico: directrices para el diagnóstico y tratamiento
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B. Llombart, Daniel Morgado-Carrasco, O. Sanmartín, I. Machado, C. Serra-Guillén, C. Requena, and Mercè Alsina
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General Medicine - Abstract
Resumen El leiomiosarcoma de la piel se clasifica en tres grupos: dermico, hipodermico y cutaneo metastasico. El dermico se origina de las fibras musculares lisas del musculo erector del pelo, dartos genital o de la areola mamaria. Se considera un tumor de malignidad intermedia, con tendencia a la recidiva local (24%) y un bajo riesgo de metastasis (4%). El leiomiosarcoma hipodermico se origina de las paredes musculares de los vasos, y se caracteriza por presentar una mayor tasa de recidiva local (37%) y metastasis (43%). El sarcoma pelomorfico dermico aparece habitualmente en pacientes ancianos y se localiza caracteristicamente en zonas de piel fotoexpuesta (cuero cabelludo). Comparte caracteristicas histologicas e inmunohistoquimicas con el fibroxantoma atipico, pero con un comportamiento mas agresivo (metastasis en el 10-20%). Los criterios histologicos que lo diferencian son la infiltracion del tejido celular subcutaneo, la infiltracion perineural y la presencia de focos de necrosis.
- Published
- 2019
17. Kaposi Sarcoma and Cutaneous Angiosarcoma: Guidelines for Diagnosis and Treatment
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Daniel Morgado-Carrasco, B. Llombart, J. Cruz, Celia Requena, Onofre Sanmartín, Carlos Serra-Guillén, and Mercè Alsina
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Male ,medicine.medical_specialty ,Poor prognosis ,Skin Neoplasms ,Histology ,medicine.medical_treatment ,Hemangiosarcoma ,Dermatology ,Pathology and Forensic Medicine ,030207 dermatology & venereal diseases ,03 medical and health sciences ,Age Distribution ,0302 clinical medicine ,medicine ,Humans ,Angiosarcoma ,Sarcoma, Kaposi ,neoplasms ,Survival rate ,Chemotherapy ,Classic Kaposi Sarcoma ,AIDS-Related Opportunistic Infections ,Radiotherapy ,business.industry ,virus diseases ,Lymphangiosarcoma ,Neoplasms, Second Primary ,medicine.disease ,Combined Modality Therapy ,Radiation therapy ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Scalp ,Herpesvirus 8, Human ,Practice Guidelines as Topic ,Female ,Sarcoma ,business - Abstract
Kaposi sarcoma is a vascular sarcoma with 4 clinical variants: classic Kaposi sarcoma, which mainly affect the extremities of elderly patients and follows a chronic, generally indolent course; African Kaposi sarcoma; immunosuppression-associated Kaposi sarcoma; and AIDS-associated Kaposi sarcoma. Type8 human herpesvirus is the etiologic agent in all 4variants. Cutaneous angiosarcoma is a cutaneous neoplasm with a very poor prognosis. It carries a high probability of local relapse and has a 10% to 15% survival rate at 5years. There are 3 main variants of cutaneous angiosarcoma: idiopathic angiosarcoma of the face and scalp; Stewart-Treves syndrome; and postradiation angiosarcoma. The only potentially curative treatment is surgery with or without radiotherapy. However, its indistinct borders and multicentric nature mean that treatment is often palliative with chemotherapy, radiotherapy, or both.
- Published
- 2018
18. Sarcomas cutáneos: directrices para el diagnóstico y tratamiento. Dermatofibrosarcoma protuberans
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B. Llombart, O. Sanmartín, Daniel Morgado-Carrasco, C. Requena, Mercè Alsina, Victor Traves, and Carlos Serra
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030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,General Medicine - Abstract
Resumen Los sarcomas constituyen un grupo amplio de tumores, muchos de ellos con comportamiento biologico y agresividad diferentes entre si, que habitualmente requieren un tratamiento multidisciplinario, frecuentemente complejo. El desarrollo en las ultimas decadas de la dermatologia quirurgica y oncologica ha permitido que los dermatologos se conviertan en los especialistas responsables del diagnostico y tratamiento del cancer cutaneo. El proposito de este articulo es revisar los principales sarcomas de partes blandas de localizacion tipicamente cutanea. El dermatofibrosarcoma protuberans es un sarcoma de bajo grado de malignidad, con un crecimiento lento e infiltrativo localmente y escasa capacidad metastasica (
- Published
- 2018
19. Sonidegib in the Treatment of Locally Advanced Basal Cell Carcinoma
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O, Sanmartín, B, Llombart, G, Carretero Hernández, Á, Flórez Menéndez, R, Botella-Estrada, E, Herrera Ceballos, and S, Puig
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Skin Neoplasms ,Carcinoma, Basal Cell ,Pyridines ,Biphenyl Compounds ,Humans ,Antineoplastic Agents ,Hedgehog Proteins - Abstract
Sonidegib is an antagonist of the transmembrane protein Smoothened in the Hedgehog signaling pathway. It is indicated for the treatment of locally advanced basal cell carcinoma (BCC) that is not amenable to curative surgery or radiotherapy. Sonidegib's efficacy and safety were demonstrated in the phase 2 BOLT trial, where 61% (95% CI, 48-72%) of patients with locally advanced BCC treated with sonidegib 200 mg achieved an objective response to treatment with a mean time to response of 4 months. The median duration of response was 26.1 months and the median progression-free survival was 22.1 months. The most common adverse events were muscle spasms (54.4%), hair loss (49.4%), and loss of taste (44.3%); most events were grade 1 or 2. In this review, we summarize the main findings on the efficacy, safety, and tolerability of sonidegib and discuss the management of locally advanced BCC with this drug.
- Published
- 2020
20. The role of
- Author
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V, López Prior and B, Llombart Cussac
- Abstract
Merkel cell carcinoma (MCC) is a rare and aggressive neuroendocrine tumor with limited evidence on the role ofFifty-one studies ofThere were 23 PET/CT positive studies (45.10%) and 28 (54.90%) negative. Thirty four (66.7%) studies were performed for assessment of stage at initial presentation and 17 (33.3%) were performed during the follow up: 6 (35.29%) for suspected recurrence; 7 (41.18%) for restaging; 4 (23.53%) as a part of ongoing surveillance. On the basis of PET/CT results, there was a change in disease stage (SC) in 20 studies (39.20%) and impact in the management (MI) in 28 (54.90%): 11 (32.40%) SC and 12 (35.30%) MI in the initial staging; 5 (71.43%) SC and 7 (100%) MI in the restaging; 3 (50.00%) SC and 6 (100%) MI in suspected recurrence; 1 (25.00%) SC and 3 (75.00%) MI in the surveillance.
- Published
- 2020
21. Tratamiento con imiquimod al 5% durante 12 días para las queratosis actínicas: estudio de la eficacia y la reacción local
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L. Calomarde, B. Llombart, Eduardo Nagore, C. Requena, C. Guillén, Onofre Sanmartín, and Carlos Serra-Guillén
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030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,030212 general & internal medicine ,General Medicine - Abstract
Resumen Introduccion y objetivos El imiquimod es un excelente tratamiento para las queratosis actinicas, sin embargo, su pauta prolongada de 4 semanas y la reaccion local que produce pueden limitar su utilizacion. Los objetivos del estudio son demostrar la eficacia del imiquimod al 5% para las queratosis actinicas aplicado en una pauta continuada de 12 dias y correlacionar el grado de reaccion local con la eficacia. Pacientes y metodos Se incluyeron pacientes con al menos 8 queratosis actinicas que se trataron con imiquimod en crema al 5% durante 12 dias seguidos. Se evaluo la reaccion local como leve, moderada o intensa. El estudio estadistico de la correlacion entre la reaccion local y la respuesta clinica se realizo con la prueba χ2 de Pearson y el test de correlacion rho de Spearman. Resultados Un total de 65 pacientes completaron el estudio. Se obtuvo un 52,3% de respuestas completas y un 75,4% de respuestas parciales. Encontramos una asociacion estadisticamente significativa entre el grado de reaccion local y la respuesta al tratamiento tanto en la prueba χ2 de Pearson como en el test de correlacion rho de Spearman. Conclusiones La pauta continuada de imiquimod al 5% aplicado durante 12 dias es eficaz para el tratamiento de las queratosis actinicas. El grado de reaccion local durante el tratamiento se correlaciona con la respuesta clinica.
- Published
- 2018
22. Angiosarcoma cutáneo: estudio clínico-patológico de 16 casos
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B. Llombart, J. Cruz, J. Lavernia, C. Requena, Victor Traves, C. Guillén, O. Sanmartín, and E. Sendra
- Subjects
03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,030212 general & internal medicine ,General Medicine - Abstract
Resumen Introduccion y objetivos El angiosarcoma primario cutaneo es uno de los tumores mas agresivos y de peor pronostico de la piel. Su clinica inicialmente indolente justifica frecuentes diagnosticos tardios, lo que sumado a su caracter muchas veces multifocal y a su mala delimitacion suele dificultar la cirugia. Debido a su baja frecuencia existen pocas series largas de casos tratados en un mismo centro. Revisamos las caracteristicas clinico-patologicas de los angiosarcomas cutaneos tratados en nuestro centro en busqueda de factores pronosticos, asi como de posibles rasgos que faciliten un diagnostico precoz. Material y metodos Se realizo un estudio observacional retrospectivo de todos los pacientes diagnosticados de angiosarcoma cutaneo atendidos en nuestro hospital entre enero de 2000 y diciembre de 2015. Se recogieron 16 parametros clinicos incluidos —entre otros— edad, sexo, tipo de angiosarcoma, localizacion, tamano, tiempo de evolucion y ademas 8 parametros histopatologicos. Resultados Se recogieron 16 pacientes con angiosarcoma cutaneo —11 mujeres y 5 varones—, la media de edad fue de 67 anos y la mediana de 71 anos. La localizacion mas frecuente fue el tronco con 10 casos, seguida de la cabeza y el cuello con 5 casos. La media del tamano tumoral fue de 10 cm y la mediana de 6,5 cm. Se realizo escision quirurgica del tumor a 14 pacientes. Tras una media de seguimiento de 42,5 meses, 6 de los 16 pacientes seguian vivos al finalizar el estudio. Conclusiones La supervivencia de los pacientes con angiosarcoma cutaneo viene determinada principalmente por el tamano tumoral y la edad. Otros rasgos asociados a peor pronostico en nuestros pacientes fueron la infiltracion a planos mas profundos (musculo), un patron histologico predominantemente solido y un mayor numero de mitosis.
- Published
- 2017
23. Actualización en el carcinoma de células de Merkel: Epidemiología, etiopatogenia, clínica, diagnóstico y estadificación
- Author
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J. Cruz, B. Llombart, and C. Requena
- Subjects
0301 basic medicine ,03 medical and health sciences ,030104 developmental biology ,0302 clinical medicine ,030220 oncology & carcinogenesis ,General Medicine - Abstract
Resumen El carcinoma de celulas de Merkel (CCM) es un tumor poco frecuente, con un curso evolutivo muy agresivo, que con frecuencia origina recidivas locorregionales y metastasis. Asienta predominantemente en zonas fotoexpuestas en pacientes ancianos. Su incidencia se ha cuadriplicado en las ultimas decadas debido al envejecimiento de la poblacion y a un mayor diagnostico gracias al uso de tecnicas inmunohistoquimicas. La patogenesis del CCM no esta clara, pero la radiacion ultravioleta, la inmunosupresion y la presencia del poliomavirus MCPyV en el genoma del tumor parecen desempenar un papel fundamental en el desarrollo de esta neoplasia. El objetivo de este articulo es realizar una revision actualizada sobre los diferentes aspectos de la epidemiologia, la etiopatogenia y la clinica del CCM. A su vez, detallamos los aspectos histologicos e inmunohistoquimicos necesarios para su diagnostico y revisamos la estadificacion por su importante trascendencia en el pronostico de estos pacientes.
- Published
- 2017
24. Actualización en el carcinoma de células de Merkel: claves de las técnicas de imagen, factores pronóstico, tratamiento y seguimiento
- Author
-
M. Chust, B. Llombart, and S. Kindem
- Subjects
030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,General Medicine - Abstract
Resumen El carcinoma de celulas de Merkel es un tumor muy poco frecuente, pero es uno de los mas agresivos a los que se puede enfrentar un dermatologo. Mas de un tercio de los pacientes fallece por esta enfermedad. Numerosos investigadores han intentado identificar los posibles factores clinico-patologicos relacionados con el pronostico de este carcinoma. Sin embargo, los resultados obtenidos en estos estudios son discordantes. Debido a la baja frecuencia y la edad avanzada de los pacientes, no se dispone de estudios prospectivos, y en consecuencia, no existe un claro algoritmo en el tratamiento. Este articulo pretende realizar una exhaustiva y comprensiva revision del carcinoma de celulas de Merkel que suponga al dermatologo una puesta al dia en este tumor. Detallamos los factores pronosticos, se revisan las tecnicas de imagen que resultan mas adecuadas para el estudio de extension y las controversias actuales relacionadas con el tratamiento.
- Published
- 2017
25. Merkel Cell Carcinoma: An Update of Key Imaging Techniques, Prognostic Factors, Treatment, and Follow-up
- Author
-
B. Llombart, S. Kindem, and M. Chust
- Subjects
Oncology ,Pathology ,medicine.medical_specialty ,Histology ,medicine.medical_treatment ,Sentinel lymph node ,Dermatology ,Disease ,Pathology and Forensic Medicine ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Medicine ,Combined Modality Therapy ,skin and connective tissue diseases ,Prospective cohort study ,integumentary system ,business.industry ,Merkel cell carcinoma ,medicine.disease ,Factors treatment ,Radiation therapy ,030220 oncology & carcinogenesis ,Age of onset ,business - Abstract
Merkel cell carcinoma, though rare, is one of the most aggressive tumors a dermatologist faces. More than a third of patients with this diagnosis die from the disease. Numerous researchers have attempted to identify clinical and pathologic predictors to guide prognosis, but their studies have produced inconsistent results. Because the incidence of Merkel cell carcinoma is low and it appears in patients of advanced age, prospective studies have not been done and no clear treatment algorithm has been developed. This review aims to provide an exhaustive, up-to-date account of Merkel cell carcinoma for the dermatologist. We describe prognostic factors and the imaging techniques that are most appropriate for evaluating disease spread. We also discuss current debates on treating Merkel cell carcinoma.
- Published
- 2017
26. Oral Contraceptives in Dermatology
- Author
-
C, Requena and B, Llombart
- Subjects
Pregnancy ,Humans ,Female ,Dermatology ,Levonorgestrel ,Ethinyl Estradiol ,Progesterone ,Contraceptives, Oral - Abstract
Oral contraceptives combine estrogen and progesterone to suppress ovulation. Synthetic forms are usually used. In dermatology, oral contraceptives are prescribed for 2 main reasons: to prevent pregnancy when teratogenic drugs must be taken and to treat skin manifestations of hyperandrogenism. Most oral contraceptives improve both acne and hirsutism, but the androgenic effect of progestogens - particularly if the contraceptive contains first- or second-generation progestogens- can trigger or exacerbate acne. One of the most serious side effects of oral contraceptives, thrombosis, is mainly caused by the estrogen component and its dose. If we mainly consider a contraceptive's thrombotic profile when prescribing, the choice would be to have 30μg or less of ethinyl estradiol combined with levonorgestrel. On the other hand, if our main objective is to treat signs of androgenization, we would prefer contraceptives containing progestogens with antiandrogenic effects.
- Published
- 2019
27. Functions of Dermatology Residents' Supervisors
- Author
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S, Medina, R, Díaz, B, Llombart, V, García-Patos, and P, Jaén
- Subjects
Internship and Residency ,Clinical Competence ,Dermatology - Published
- 2019
28. Estudio de los factores histológicos asociados a la infiltración en profundidad en el dermatofibrosarcoma protuberans
- Author
-
S. Kindem, N. Rivas, C. Requena, B. Llombart, C. Guillén, L. Calomarde, E. Nagore, O. Sanmartín, and C. Serra-Guillén
- Subjects
030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,General Medicine - Abstract
Resumen Introduccion El dermatofibrosarcoma protuberans (DFSP) es un raro tumor cutaneo de crecimiento lento e infiltrativo que alcanza el tejido celular subcutaneo, el tejido muscular e incluso el hueso. Objetivos Buscar las caracteristicas histologicas asociadas a una mayor agresividad local en los DFSP, en forma de afectacion en profundidad. Material y metodos Se relaciono las caracteristicas histologicas propias del DFSP (forma de infiltrar el tejido celular subcutaneo, patron histologico, tipo celular, areas de fibrosarcoma) con la presencia o ausencia de afectacion de la fascia muscular. Resultados Se incluyeron 155 casos de DFSP. Las caracteristicas histologicas asociadas significativamente con la afectacion de la fascia muscular fueron: el patron histologico en sabana, un alto grado de pleomorfismo celular y la presencia de mas de una mitosis. En la mayoria de los casos (62,6%) el tumor se limito al tejido celular subcutaneo, en 17 casos (11%) contacto con la fascia muscular o con la galea aponeurotica, y en 36 casos (23,2%) afecto al tejido muscular. Conclusiones Es importante tener en cuenta el patron histologico, el pleomorfismo y el numero de mitosis en los DFSP para predecir su afectacion en profundidad (fascia o musculo), que puede llegar al 30% de los casos.
- Published
- 2016
29. The Rising Incidence of Merkel Cell Carcinoma
- Author
-
B, Llombart
- Subjects
Carcinoma, Merkel Cell ,Skin Neoplasms ,Incidence ,Humans - Published
- 2018
30. Diagnosis and Treatment of Merkel Cell Carcinoma in Specialized Dermatology Units: A Clinical Practice Guideline of the Spanish Academy of Dermatology and Venereology
- Author
-
J, Vázquez Doval, B, Llombart Cussac, A, Pérez Bustillo, S, Paradela de la Morena, M J, Fuente González, M T, Fernández Figueras, M J, Villanueva, N, Rodríguez Salas, M Á, Descalzo-Gallego, I, García-Doval, and L, Ríos-Buceta
- Subjects
Carcinoma, Merkel Cell ,Evidence-Based Medicine ,Skin Neoplasms ,Spain ,Hospital Departments ,Humans ,Dermatology ,Hospital Units ,Neoplasm Staging - Abstract
Merkel cell carcinoma is a rare, aggressive skin cancer that is managed in a great variety of ways. However, international clinical practice guidelines give only partial coverage to issues considered major problems.The recommendations presented here aim to provide Spanish dermatologists with a guide to improving disputed aspects of diagnosis, staging, and treatment of localized Merkel cell carcinomas.The ADAPTE process was used. Members of the Spanish Group of Oncologic Dermatology and Surgery (GEDOC) with experience in treating Merkel cell carcinoma and interest in drafting these guidelines were selected. The group described the care process and listed the most important clinical questions. They then searched for guidelines and assessed them with the AGREE II (Appraisal of Guidelines for Research and Evaluation) tool. After consulting the guidelines for answers to their clinical questions, the group drafted the present statementand sent it for external review.The guidelines that scored highest in the AGREE II assessment step were the consensus-based interdisciplinary guideline of the European Association of Dermato-Oncology and the European Organization of Research and Treatment of Cancer, and those of the Comprehensive Cancer Network, the Alberta Health Services in Canada, the American Cancer Society, and the Cutaneous Oncology Group of the French Society of Dermatology. A total of 9 clinical questions were answered based on these guidelines.The guidelines presented here answer clinical questions that arise in routine practice. They can provide dermatologists with a starting point for decision-making, although available resources and patient preferences must always be borne in mind.
- Published
- 2018
31. Experience With Vismodegib in the Treatment of Advanced Basal Cell Carcinoma at a Cancer Center
- Author
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E, Bernia, B, Llombart, C, Serra-Guillén, B, Bancalari, E, Nagore, C, Requena, L, Calomarde, A, Diago, J, Lavernia, V, Traves, C, Guillén, and O, Sanmartín
- Subjects
Adult ,Aged, 80 and over ,Male ,Skin Neoplasms ,Carcinoma, Basal Cell ,Pyridines ,Humans ,Anilides ,Female ,Middle Aged ,Aged ,Neoplasm Staging ,Retrospective Studies - Abstract
Vismodegib is the first selective Hedgehog inhibitor approved for the treatment of locally advanced and metastatic basal cell carcinoma (BCC). In this article, we describe our experience with the use of this drug to treat advanced and/or multiple BCCs at a cancer center over 5 years.We analyzed the following variables: patient age and sex; tumor location, size, type, and characteristics; time since onset; primary or recurrent status; duration of treatment; response to treatment (complete, partial, stabilization, or absence of response); adverse effects; and recurrences.We treated 22 patients, of whom 20 had locally advanced BCCs and 2 had metastatic BCCs with lymph node involvement. The treatment was administered over a mean of 11.8 months. Nine patients (41%) achieved complete response and 10 (45%) partial response. The disease was stabilized in 3 (14%). Two patients relapsed after a median of 21 months. The main adverse effects were dysgeusia, alopecia, and muscle cramps, all of which were mild. None of the patients developed squamous cell carcinoma in an area treated with vismodegib, although metatypical changes were observed after treatment.With a response rate of 96%, vismodegib is a safe and effective treatment for locally advanced BCC. Adverse effects are generally mild but they need to be taken into account owing to their high frequency.
- Published
- 2018
32. Parotid Fistula After Skin Biopsy: Treatment With Botulinum Toxin
- Author
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B, Bancalari, B, Llombart, C, Requena, and J B, Vendrell
- Subjects
Fistula ,Biopsy ,Cutaneous Fistula ,Photography ,Humans ,Parotid Gland ,Female ,Parotid Diseases ,Sialorrhea ,Botulinum Toxins, Type A ,Aged - Published
- 2017
33. Cutaneous Leiomyosarcoma: On the Importance of Histologic Location
- Author
-
B, Llombart
- Subjects
Leiomyosarcoma ,Skin Neoplasms ,Humans ,Prognosis - Published
- 2017
34. Dermatomiositis paraneoplásica: estudio de 12 casos
- Author
-
B. Llombart, O. Sanmartín, A. Alfaro, C. Requena, Carlos Serra, C. Guillén, A. Martorell, E. Nagore, and Victor Traves
- Subjects
General Medicine - Abstract
Resumen Introduccion y objetivos La dermatomiositis del adulto es paraneoplasica hasta en una cuarta parte de los casos. Hasta la fecha no existe ningun rasgo clinico, histologico o analitico absolutamente especifico de paraneoplasia en dermatomiositis. Ademas, los estudios sobre dermatomiositis del adulto no suelen hacer referencia a la frecuencia de aparicion de los distintos signos cutaneos propios de la dermatomiositis en los casos asociados a cancer. Por todo ello decidimos revisar nuestros casos de dermatomiositis paraneoplasicas. Material y metodos Estudiamos 12 casos de dermatomiositis paraneoplasicas en los cuales se recogio la edad, el sexo, el cancer asociado, el tiempo entre el inicio de la dermatomiositis y el cancer, 9 signos cutaneos, afectacion muscular, disfagia, enfermedad pulmonar, niveles de creatinfosfocinasa y de autoanticuerpos circulantes. Resultados La media de edad fue de 61 anos y los 2 canceres asociados mas frecuentes fueron el de ovario y el de vejiga. El tiempo medio transcurrido entre el diagnostico del cancer y el de la dermatomiositis fue de 7 meses, y en la mayoria el diagnostico de cancer precedio al de dermatomiositis. Siete pacientes tuvieron dermatomiositis amiopatica. De los signos cutaneos, los mas frecuentes fueron una erupcion violacea fotodistribuida que respetaba la region interescapular y el rash heliotropo, seguidos de las papulas de Gottron y la afectacion de cuticulas. Se encontro necrosis cutanea superficial en 3 casos. Los autoanticuerpos especificos de miositis resultaron negativos en los 6 casos estudiados. Conclusiones La dermatomiositis paraneoplasica es muchas veces amiopatica. No existe ningun rasgo cutaneo especifico de paraneoplasia en la dermatomiositis. Los anticuerpos especificos de miositis no se asocian a la dermatomiositis paraneoplasica.
- Published
- 2014
35. Cutaneous Angiosarcoma: Clinical and Pathology Study of 16 Cases
- Author
-
C, Requena, E, Sendra, B, Llombart, O, Sanmartín, C, Guillén, J, Lavernia, V, Traves, and J, Cruz
- Subjects
Adult ,Aged, 80 and over ,Male ,Neoplasms, Radiation-Induced ,Skin Neoplasms ,Radiotherapy ,Hemangiosarcoma ,Breast Neoplasms ,Neoplasms, Second Primary ,Cancer Care Facilities ,Middle Aged ,Prognosis ,Combined Modality Therapy ,Head and Neck Neoplasms ,Antineoplastic Combined Chemotherapy Protocols ,Humans ,Female ,Radiotherapy, Adjuvant ,Lymphedema ,Early Detection of Cancer ,Aged ,Follow-Up Studies ,Retrospective Studies - Abstract
Primary cutaneous angiosarcoma is one of the most aggressive skin tumors and carries a very poor prognosis. Its initially indolent clinical presentation explains the frequently late diagnosis that, together with its typically multifocal pattern and poor delimitation, often makes surgery difficult. The low incidence of primary cutaneous angiosarcoma means that few large single-center series have been published. We review the clinical and pathologic characteristics of cutaneous angiosarcomas treated in our hospital, looking for prognostic factors and for possible diagnostic traits that could facilitate early diagnosis.This was a retrospective observational study including all patients diagnosed with cutaneous angiosarcoma in Instituto Valenciano de Oncología in Valencia, Spain between January 2000 and December 2015. We recorded 16 clinical parameters, including age, sex, type of angiosarcoma, site, size, and time since diagnosis, and 8 histopathologic parameters.We identified 16 patients (11 women and 5 men) with cutaneous angiosarcoma. Their mean age was 67 years (median, 71 years). The most common site was the trunk (10 cases), followed by the head and neck (5 cases). The mean size of the tumor was 10cm (median, 6.5cm). Fourteen patients underwent surgical excision. Six of the 16 patients were alive at the end of the study, after a mean follow-up period of 42.5 months.The major determinants of survival among patients with cutaneous angiosarcoma are tumor size and patient age. Other characteristics associated with a poor prognosis were infiltration of deep planes (muscle), a predominantly solid histologic pattern, and a larger number of mitoses.
- Published
- 2016
36. Carcinoma de células de Merkel, un tumor en auge
- Author
-
B. Llombart
- Subjects
General Medicine - Published
- 2019
37. The Rising Incidence of Merkel Cell Carcinoma
- Author
-
B. Llombart
- Subjects
medicine.medical_specialty ,Histology ,business.industry ,Merkel cell carcinoma ,Incidence (epidemiology) ,Medicine ,Dermatology ,business ,medicine.disease ,Pathology and Forensic Medicine - Published
- 2019
38. Estudio descriptivo de la presentación clínica del melanoma lentiginoso acral
- Author
-
C. Serra-Guillén, O. Sanmartín, Victor Traves, B. Llombart, C. Guillén, C. Requena, E. Nagore, and C. Pereda
- Subjects
General Medicine - Abstract
Resumen El melanoma lentiginoso acral (MLA) es el tipo de melanoma de localizacion acral mas frecuente y suele diagnosticarse en estadios mas avanzados que el resto de los tipos de melanoma. El objetivo de nuestro estudio fue conocer las caracteristicas de presentacion clinica del MLA. Material y metodos Se realizo un estudio descriptivo observacional restrospectivo a partir de los pacientes recogidos en la base de datos del Instituto Valenciano de Oncologia (IVO). Mediante encuestas telefonicas a los pacientes se recogieron las caracteristicas de presentacion de la lesion, en particular la presencia de los signos y sintomas incluidos en las reglas del ABCDE y de los 7 puntos de Glasgow, asi como el retraso en el diagnostico atribuible al paciente o al medico. Resultados En una muestra final de 23 pacientes que pudieron responder finalmente a la encuesta se constato que el diagnostico se demoro mas de un ano por un retraso en la consulta por parte del paciente en un 30,4%. Por otra parte, hubo una demora de mas de un ano atribuible al medico que no sospecho el diagnostico en un 20% de los casos. Respecto a los motivos mas frecuentes de consulta estos fueron: cambios en el tamano, en el color, sangrado y herida que no cura. En un 20% de los casos que fueron evaluados por un medico la decision de realizar el estudio histologico se demoro mas de un ano. Conclusiones Existe un importante retraso en el diagnostico del MLA debido tanto al paciente como al medico, lo que es achacable en parte a una falta de reconocimiento de los signos de alarma en lo que concierne al paciente y al personal sanitario. Las campanas preventivas del melanoma deberian poner mas enfasis en la posible afectacion de las palmas y sobre todo de las plantas.
- Published
- 2013
39. Merkel Cell Carcinoma: An Update of Key Imaging Techniques, Prognostic Factors, Treatment, and Follow-up
- Author
-
B, Llombart, S, Kindem, and M, Chust
- Subjects
Male ,Neoplasms, Radiation-Induced ,Skin Neoplasms ,Antineoplastic Agents ,Risk Factors ,Positron Emission Tomography Computed Tomography ,Humans ,Age of Onset ,Aged ,Aged, 80 and over ,Sentinel Lymph Node Biopsy ,Middle Aged ,Prognosis ,Combined Modality Therapy ,Immunohistochemistry ,Magnetic Resonance Imaging ,Carcinoma, Merkel Cell ,Treatment Outcome ,Lymphatic Metastasis ,Sunlight ,Lymph Node Excision ,Female ,Radiotherapy, Adjuvant ,Immunotherapy ,Tomography, X-Ray Computed ,Follow-Up Studies - Abstract
Merkel cell carcinoma, though rare, is one of the most aggressive tumors a dermatologist faces. More than a third of patients with this diagnosis die from the disease. Numerous researchers have attempted to identify clinical and pathologic predictors to guide prognosis, but their studies have produced inconsistent results. Because the incidence of Merkel cell carcinoma is low and it appears in patients of advanced age, prospective studies have not been done and no clear treatment algorithm has been developed. This review aims to provide an exhaustive, up-to-date account of Merkel cell carcinoma for the dermatologist. We describe prognostic factors and the imaging techniques that are most appropriate for evaluating disease spread. We also discuss current debates on treating Merkel cell carcinoma.
- Published
- 2016
40. Leiomiosarcoma cutáneo: la importancia de la localización histológica
- Author
-
B. Llombart
- Subjects
business.industry ,Medicine ,General Medicine ,business - Published
- 2018
41. Cutaneous Leiomyosarcoma: On the Importance of Histologic Location
- Author
-
B. Llombart
- Subjects
Leiomyosarcoma ,medicine.medical_specialty ,Histology ,business.industry ,MEDLINE ,Dermatology ,medicine.disease ,Pathology and Forensic Medicine ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,medicine ,business ,Cutaneous leiomyosarcoma - Published
- 2018
42. Successful treatment of hereditary multiple glomangiomas with Nd:YAG laser
- Author
-
C. Saus, A. Martín-Santiago, B. Llombart, and S. Kindem
- Subjects
Infectious Diseases ,business.industry ,Nd:YAG laser ,Medicine ,Dermatology ,Nuclear medicine ,business ,Glomangioma - Published
- 2013
43. Microcystic Adnexal Carcinoma: Mohs Micrographic Surgery as the Treatment of Choice
- Author
-
C. Requena-Caballero, B. Llombart-Cussac, Rafael Botella-Estrada, O. Sanmartín-Jiménez, Antonio Martorell-Calatayud, S. Almenar-Medina, C. Guillén-Barona, Carlos Serra-Guillén, E. Nagore-Enguídanos, and B. Echeverría-García
- Subjects
medicine.medical_specialty ,Histology ,business.industry ,Wide local excision ,medicine.medical_treatment ,Perineural invasion ,Dermatology ,medicine.disease ,Primary tumor ,Pathology and Forensic Medicine ,Surgery ,Subcutaneous nodule ,Atypia ,medicine ,Mohs surgery ,Basal cell carcinoma ,business ,Microcystic adnexal carcinoma - Abstract
Introduction and objectives Microcystic adnexal carcinoma is a rare and aggressive tumor that manifests clinically as a subcutaneous nodule located on the head or neck. The tumor can be confused clinically and histologically with other benign and malignant skin lesions, often leading to inappropriate initial treatment. The chief concern with microcystic adnexal carcinoma is the elevated morbidity and the high rate of recurrence after wide local excision. Recent preliminary studies point to higher cure rates with Mohs micrographic surgery. Material and methods We reviewed the medical histories of 6 consecutive patients with microcystic adnexal carcinoma who underwent Mohs micrographic surgery in our dermatology department between 1995 and 2007. Results In all cases, lesions were located on the head and were primary tumors. Seventy percent of the tumors were wrongly diagnosed initially as basal cell carcinoma. Perineural invasion was not detected in any patient, and all were free of recurrence after between 1 and 12 years of postoperative follow-up. Conclusions The absence of perineural involvement and substantial cell atypia can be attributed to the lesions being primary tumors. This would provide a rationale for definitive radical treatment of the primary tumor from the outset to avoid the complications associated with recurrence. The site and the absence of recurrence in all our patients who underwent Mohs micrographic surgery support the use of this technique as the treatment of choice in microcystic adnexal carcinoma.
- Published
- 2009
44. Carcinoma anexial microquístico: la cirugía micrográfica de Mohs como tratamiento de elección
- Author
-
E. Nagore-Enguídanos, O. Sanmartín-Jiménez, C. Serra-Guillén, B. Llombart-Cussac, C. Requena-Caballero, C. Guillén-Barona, B. Echeverría-García, S. Almenar-Medina, Antonio Martorell-Calatayud, and R. Botella-Estrada
- Subjects
medicine.medical_specialty ,business.industry ,Wide local excision ,medicine.medical_treatment ,Perineural invasion ,General Medicine ,medicine.disease ,Primary tumor ,Surgery ,Subcutaneous nodule ,Atypia ,Medicine ,Initial treatment ,Basal cell carcinoma ,business ,Microcystic adnexal carcinoma - Abstract
Introduction and objectives. Microcystic adnexal carcinoma is a rare and aggressive tumor that manifests clinically as a subcutaneous nodule located on the head or neck. The tumor can be confused clinically and histologically with other benign and malignant skin lesions, often leading to inappropriate initial treatment. The chief concern with microcystic adnexal carcinoma is the elevated morbidity and the high rate of recurrence after wide local excision. Recent preliminary studies point to higher cure rates with Mohs micrographic surgery. Material and methods. We reviewed the medical histories of 6 consecutive patients with microcystic adnexal carcinoma who underwent Mohs micrographic surgery in our dermatology department between 1995 and 2007. Results. In all cases, lesions were located on the head and were primary tumors. Seventy percent of the tumors were wrongly diagnosed initially as basal cell carcinoma. Perineural invasion was not detected in any patient, and all were free of recurrence after between 1 and 12 years of postoperative follow-up. Conclusions. The absence of perineural involvement and substantial cell atypia can be attributed to the lesions being primary tumors. This would provide a rationale for definitive radical treatment of the primary tumor from the outset to avoid the complications associated with recurrence. The site and the absence of recurrence in all our patients who underwent Mohs micrographic surgery support the use of this technique as the treatment of choice in microcystic adnexal carcinoma.
- Published
- 2009
45. Perfil clínico y epidemiológico de los pacientes con melanoma cutáneo según el grado de exposición solar de la localización del melanoma
- Author
-
A. Martorell, C. Guillén, E. Nagore, L. Hueso, Carlos Serra-Guillén, R. Botella-Estrada, C. Requena, B. Llombart, and O. Sanmartín
- Subjects
business.industry ,Medicine ,General Medicine ,Sun exposure ,business ,Humanities - Abstract
Resumen Introduccion Se ha observado que los melanomas tienen un perfil genetico similar segun el patron de exposicion al sol del area cutanea donde asientan. El objetivo de este estudio ha sido caracterizar desde el punto de vista clinico los pacientes con melanoma segun su patron de exposicion al sol: cronico, intermitente y ausencia de exposicion. Material y metodos Se seleccionaron 789 pacientes con melanoma diagnosticados en nuestro centro de forma consecutiva desde enero del ano 2000 a partir de la base de datos de melanoma. Se obtuvieron los datos referentes a las caracteristicas epidemiologicas, fenotipicas y los antecedentes personales y familiares de cancer. Se compararon las frecuencias observadas de cada una de las variables estudiadas. Resultados Se observo que la mayoria de los pacientes tienen los melanomas en localizaciones expuestas al sol de forma intermitente. Ademas, estos pacientes tienen mas nevus melanociticos tanto comunes como atipicos y su melanoma se asocia con una elevada frecuencia a un nevus preexistente. Por otra parte, el segundo grupo en numero esta constituido por el grupo de pacientes con melanomas en areas cutaneas expuestas al sol de forma cronica que presentaron todas las lesiones (lentigos solares y queratosis actinicas) y antecedentes tipicos de esta localizacion. Finalmente, el grupo de melanomas que se presenta en areas de piel no expuestas al sol tiene, al igual que el anterior, una edad de diagnostico mayor y se diagnostican en fases avanzadas de la enfermedad. Conclusiones La presencia de un elevado numero de pacientes que no sigue ninguno de los patrones mencionados suscita la necesidad de caracterizarlos clinica y biologicamente para conocer vias alternativas de desarrollo de un melanoma, y asi poder establecer medidas preventivas adecuadas.
- Published
- 2009
46. Nódulo angiomatoso epitelioide cutáneo proliferativo
- Author
-
C. Requena, B. Llombart, R. Haro, M.J. Nicolau, O. Sanmartín, A. Martorell, R. Botella, L. Requena, and C. Guillen
- Subjects
General Medicine - Abstract
Resumen El nodulo angiomatoso epitelioide cutaneo es una proliferacion vascular poco frecuente de naturaleza benigna y de reciente descripcion. Clinicamente es una lesion rojiza, pequena, papulosa o nodular, habitualmente unica, de crecimiento rapido en el tronco o las extremidades de una persona adulta. Histopatologicamente se trata de una proliferacion de celulas de habito epitelioide y crecimiento predominantemente solido, bien delimitada, unilobular, localizada en la dermis superficial. Es comun encontrar vasos bien conformados salpicando la lesion, asi como cierto infiltrado inflamatorio acompanante. Las celulas muestran amplios citoplasmas rosados, muchas veces con vacuolas, y nucleos vesiculosos con nucleolos prominentes. La morfologia de las celulas es relativamente uniforme y no se encuentran atipias ni pleomorfismo, aunque no son raras las mitosis. Describimos dos nuevos casos de nodulo angiomatoso epitelioide cutaneo, el primero en una mujer embarazada de 28 anos y el segundo en un varon de 27 anos, ambos con todos los rasgos descritos como propios de esta entidad, pero con la peculiaridad de que presentaban un elevado indice mitosico. Discutimos el diagnostico diferencial entre el nodulo angiomatoso epitelioide cutaneo y otras proliferaciones vasculares con citologia epitelioide
- Published
- 2009
47. Eritema acral inducido por quimioterapia
- Author
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Carlos Serra-Guillén, E. Nagore, A. Alfaro-Rubio, C. Guillén, O. Sanmartín, B. Llombart, C. Requena, L. Hueso, and R. Botella-Estrada
- Subjects
Gynecology ,medicine.medical_specialty ,business.industry ,Acrodermatitis ,Medicine ,General Medicine ,business ,medicine.disease ,Acral erythema - Abstract
Resumen Introduccion El eritema acral (EA) es una reaccion cutanea relativamente frecuente producida por diferentes agentes quimioterapicos. Otros terminos con los que se le conoce son eritrodisestesia palmoplantar o sindrome pie-mano. Se presenta como un eritema doloroso en palmas y plantas asociado a parestesias en el contexto de un tratamiento oncologico. El EA parece ser dosis-dependiente, y tanto el pico plasmatico como la dosis acumulada del quimioterapico determinan su aparicion. La clinica y los hallazgos histopatologicos sugieren una citotoxicidad directa de la epidermis acral por las altas concentraciones de los quimioterapicos. Los agentes mas frecuentemente implicados son doxorrubicina, 5-fluorouracilo y derivados, citarabina y docetaxel. Material y metodos Se presentan las caracteristicas clinicas e histologicas de una serie de pacientes diagnosticados de eritema acral por quimioterapicos. Se incluyeron en el trabajo todos los pacientes sometidos a quimioterapia que desarrollaron lesiones de eritema acral durante un periodo de tiempo comprendido entre enero de 2000 y diciembre de 2003. Resultados y conclusion Se encontraron 44 casos entre los 2.186 pacientes sometidos a quimioterapia, lo que supuso una incidencia del 2,01 % durante el periodo de estudio, y el 16,75 % de todas las lesiones cutaneas atribuidas a la quimioterapia. El farmaco mas frecuentemente relacionado fue el 5-fluorouracilo en infusion continua, y la mayor incidencia se dio en pacientes tratados con doxorrubicina liposomial. El EA fue toxicidad limitante de dosis en el 29,5% de los casos. Los hallazgos histologicos variaron segun la intensidad clinica de las lesiones, encontrando una dermatitis de interfase con necrosis de queratinocitos variable, dilatacion del plexo vascular superficial y un escaso infiltrado inflamatorio. El tratamiento mas utilizado fue la piridoxina y las medidas locales como fomentos frios, emolientes y corticoids topicos.
- Published
- 2008
48. Síndrome de Stewart-Bluefarb
- Author
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Carlos Serra-Guillén, Mónica González, R. Botella-Estrada, B. Cano, E. Nagore, A. Alfaro-Rubio, L. Hueso, C. Requena, C. Guillén, O. Sanmartín, and B. Llombart
- Subjects
Pathology ,medicine.medical_specialty ,Vascular disease ,business.industry ,Arterial disease ,Arteriovenous fistula ,Arteriovenous malformation ,General Medicine ,medicine.disease ,medicine ,Sarcoma ,Acroangiodermatitis ,Congenital disease ,business ,Skin lesion - Abstract
Stewart-Bluefarb syndrome is a rare condition involving skin lesions that share clinical features with Kaposi sarcoma and that are secondary to an underlying arteriovenous fistula. We report the case of a 24-year-old man with progressive growth of skin lesions on the lower third of his left leg. Diagnosis of Stewart-Bluefarb syndrome was confirmed histologically and with detection of an arteriovenous fistula.
- Published
- 2007
49. Dermatofibrosarcoma protuberans
- Author
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O, Sanmartín, B, Llombart, J A, López-Guerrero, C, Serra, C, Requena, and C, Guillén
- Subjects
Skin Neoplasms ,Histology ,Oncogene Proteins, Fusion ,Chromosomes, Human, Pair 22 ,Antigens, CD34 ,Antineoplastic Agents ,Dermatology ,Piperazines ,Translocation, Genetic ,Pathology and Forensic Medicine ,Receptor, Platelet-Derived Growth Factor beta ,Biomarkers, Tumor ,Humans ,Neoplasm Invasiveness ,Ring Chromosomes ,Dermatofibrosarcoma ,Sarcoma ,General Medicine ,Mohs Surgery ,Prognosis ,Combined Modality Therapy ,Neoadjuvant Therapy ,Neoplasm Proteins ,Pyrimidines ,Chemotherapy, Adjuvant ,Drug Design ,Benzamides ,Imatinib Mesylate ,Neoplasm Recurrence, Local ,Chromosomes, Human, Pair 17 - Abstract
Dermatofibrosarcoma protuberans (DFSP) is a soft tissue neoplasm of intermediate malignancy that is initially localized to the skin from where it can invade deep structures (fat, fascia, muscle and bone). It is the most frequent fibrohistiocytic tumor, comprising approximately 1.8 % of all soft tissue sarcomas and 0.1 % of all cancers. It has an estimated incidence of 0.8-5 cases per one million persons per year. Treatment of localized disease consists in complete surgical excision of the lesion by conventional surgery with wide margins (3 cm) or by micrographic Mohs surgery. Although the cases of metastatic DFSP do not reach 5 % of the total, almost all of them appear after previous local relapses. The prognosis for metastatic cases is very poor with a survival of less than 2 years following detection of metastatic disease. Patients with locally advanced DFSP are not candidates for an initial radical surgical therapy therefore neoadyuvant treatment is required prior to surgery in order to reduce tumor burden. In this regard, chemotherapy and radiotherapy have not been highly efficacious so it is necessary to consider new alternatives. The demonstration of the oncogenic power of the translocation COL1A1-PDGFB in DFSP has allowed the successful introduction of drug therapy with antagonists of the PDGFB receptor for metastatic or locally advanced cases.
- Published
- 2007
50. Histologic Features Associated with Deep Invasion in Dermatofibrosarcoma Protuberans
- Author
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C, Serra-Guillén, B, Llombart, E, Nagore, C, Guillén, C, Requena, S, Kindem, N, Rivas, L, Calomarde, and O, Sanmartín
- Subjects
Skin Neoplasms ,Dermatofibrosarcoma ,Humans ,Neoplasm Invasiveness ,Retrospective Studies - Abstract
Dermatofibrosarcoma protuberans (DFSP) is a rare, slow-growing cutaneous tumor that can invade the subcutaneous tissue, muscle tissue, and even bone.To identify histologic features associated with greater depth of invasion, i.e., local aggressiveness, in DFSP.We analyzed associations between histologic features of DFSP (e.g., type of subcutaneous invasion, histologic pattern, cell type, areas of fibrosarcoma) and the presence and absence of muscle fascia involvement.We studied 155 cases of DFSP. The following histologic characteristics were significantly associated with involvement of the muscle fascia: the presence of a sheetlike pattern, a high degree of cellular pleomorphism, and more than 1 mitotic figure. The tumor did not extend beyond the subcutaneous tissue in the majority of cases (62.6%), but there was involvement of the fascia or galea aponeurotica in 17 cases (11%) and of the muscle tissue in 36 cases (23.2%).Histologic patterns, degree of pleomorphism, and number of mitotic figures are important predictors of deep invasion (fascia or muscle) in DFSP; these layers can be involved in up to 30% of cases.
- Published
- 2015
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