52 results on '"B, Llombart"'
Search Results
2. Avelumab to treat Merkel cell carcinoma: real-life experience in a dedicated oncology center.
- Author
-
Ríos-Viñuela E, García-Vázquez M, Juan MJ, Nagore E, Requena C, Sanmartín O, and Llombart B
- Abstract
The arrival of immunotherapy has revolutioned the management of patients with metastatic Merkel cell carcinoma (MCC). We conducted an observational, retrospective study of 14 cases treated with avelumab. The response rate was 57%: complete response was reached in 29% of patients, and partial responses in 29%. The drug proved effective in 83% (5/6) of the patients with a single metastatic site. However, the disease progressed in 75% (3/4) of the patients with bone metastases. PD1-L expression, MCC polyomavirus (MCPyV) positivity, and an impaired neutrophil-to-lypmhocyte ratio (NLR) could not be associated with responses to the therapy. Avelumab is an effective and safe drug for the management of advanced MCC, and its effectiveness appears to be impacted by the number and location of metastases., (Copyright © 2024. Publicado por Elsevier España, S.L.U.)
- Published
- 2024
- Full Text
- View/download PDF
3. Lymphovascular Invasion and High Mitotic Count Are Associated With Increased Risk of Recurrence in Pleomorphic Dermal Sarcoma.
- Author
-
Pons Benavent M, Ríos-Viñuela E, Nagore E, Monteagudo C, Aguerralde M, Mata Cano D, Llombart B, Serra-Guillén C, Pinazo Canales I, Requena C, and Sanmartín O
- Subjects
- Humans, Necrosis complications, Neoplasm Recurrence, Local epidemiology, Prognosis, Retrospective Studies, Bone Neoplasms complications, Sarcoma pathology, Skin Neoplasms pathology
- Abstract
Background and Objective: Atypical fibroxanthoma and pleomorphic dermal sarcoma (PDS) are rare mesenchymal tumors. Due to the low incidence of PDS and a historically confusing nomenclature, little is known about the true aggressiveness of this tumor. The aim of this study was to investigate clinical and histologic risk factors for recurrence in PDS., Material and Methods: Retrospective, observational, bicentric study of 31 PDSs diagnosed and treated at Hospital Clínico Universitario de Valencia and Instituto Valenciano de Oncología in Valencia, Spain, between 2005 and 2020. We described the clinical and histologic features of these tumors and performed univariate analysis and multivariate Cox regression analysis., Results: In the univariate analysis, tumor recurrence (P<.001), necrosis (P=.020), lymphovascular invasion (P=.037), perineural invasion (P=.041), and mitotic count (<18 vs ≥18 mitoses per 10 high-power fields) (P=.093) were associated with worse disease-free survival. In the multivariate Cox regression analysis, mitotic count and lymphovascular invasion retained their significance as predictors of worse disease-free survival (P<.05)., Conclusions: PDS is an aggressive tumor in which a high mitotic count (≥18) and lymphovascular invasion are associated with a higher risk of recurrence and worse disease-free survival. Necrosis and perineural invasion are also probably linked to increased tumor aggressiveness., (Copyright © 2023 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.)
- Published
- 2023
- Full Text
- View/download PDF
4. Cemiplimab in Advanced Cutaneous Squamous Cell Carcinoma: Real-World Experience in a Monographic Oncology Center.
- Author
-
Ríos-Viñuela E, Álvarez P, Lavernia J, Serra-Guillén C, Requena C, Bernia E, Diago A, Llombart B, and Sanmartín O
- Subjects
- Antibodies, Monoclonal, Humanized adverse effects, Humans, Immunotherapy, Carcinoma, Squamous Cell drug therapy, Carcinoma, Squamous Cell pathology, Skin Neoplasms drug therapy, Skin Neoplasms pathology
- Abstract
Management of advanced cSCC is challenging, and many available systemic medications have modest efficacy. Cemiplimab has demonstrated efficacy in the treatment of advanced cSCC in clinical trials, but real-world data are still limited. With the objective of evaluating the efficacy of cemiplimab in a real-world clinical setting, we conducted a prospective observational study of 13 patients with advanced cSCC. Six patients (46%) had locally advanced disease, while 7 (54%) had metastatic disease. A total of 8 patients (62%) responded to cemiplimab. Five (38%) showed a partial response, while 3 (23%) showed a complete response. Four patients with an initial partial response presented subsequent disease progression during follow-up. Six patients (46%) developed AEs, most of which were mild (G1). PFS was 5.9 months, with a median follow-up was 9 months. In conclusion, cemiplimab demonstrated its utility in the treatment of advanced cSCC, with acceptable response rates, a remarkable number of complete responses, and a very good safety profile., (Copyright © 2022. Publicado por Elsevier España, S.L.U.)
- Published
- 2022
- Full Text
- View/download PDF
5. Cemiplimab in Advanced Cutaneous Squamous Cell Carcinoma: Real-World Experience in a Monographic Oncology Center.
- Author
-
Ríos-Viñuela E, Álvarez P, Lavernia J, Serra-Guillén C, Requena C, Bernia E, Diago A, Llombart B, and Sanmartín O
- Subjects
- Antibodies, Monoclonal, Humanized adverse effects, Humans, Immunotherapy, Carcinoma, Squamous Cell drug therapy, Carcinoma, Squamous Cell pathology, Skin Neoplasms drug therapy, Skin Neoplasms pathology
- Abstract
Management of advanced cSCC is challenging, and many available systemic medications have modest efficacy. Cemiplimab has demonstrated efficacy in the treatment of advanced cSCC in clinical trials, but real-world data are still limited. With the objective of evaluating the efficacy of cemiplimab in a real-world clinical setting, we conducted a prospective observational study of 13 patients with advanced cSCC. Six patients (46%) had locally advanced disease, while 7 (54%) had metastatic disease. A total of 8 patients (62%) responded to cemiplimab. Five (38%) showed a partial response, while 3 (23%) showed a complete response. Four patients with an initial partial response presented subsequent disease progression during follow-up. Six patients (46%) developed AEs, most of which were mild (G1). PFS was 5.9 months, with a median follow-up was 9 months. In conclusion, cemiplimab demonstrated its utility in the treatment of advanced cSCC, with acceptable response rates, a remarkable number of complete responses, and a very good safety profile., (Copyright © 2022 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.)
- Published
- 2022
- Full Text
- View/download PDF
6. The role of 18 F-FDG PET/CT in the management of Merkel cell carcinoma: The experience of 51 studies in our institution.
- Author
-
López Prior V and Llombart Cussac B
- Abstract
Objectives: Merkel cell carcinoma (MCC) is a rare and aggressive neuroendocrine tumor with limited evidence on the role of
18 F-FDG PET/CT. The aim of this study was to assess the impact of the18 F-FDG PET/CT in the management of MCC., Methods: Fifty-one studies of18 F-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.18 F-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 positive18 F-FDG PET/CT but the trend did not reach statistical significance., Conclusion:18 F-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 of18 F-FDG PET/CT on the management of MCC patients., (Copyright © 2020 Sociedad Española de Medicina Nuclear e Imagen Molecular. Publicado por Elsevier España, S.L.U. All rights reserved.)- Published
- 2021
- Full Text
- View/download PDF
7. Sonidegib in the Treatment of Locally Advanced Basal Cell Carcinoma.
- Author
-
Sanmartín O, Llombart B, Carretero Hernández G, Flórez Menéndez Á, Botella-Estrada R, Herrera Ceballos E, and Puig S
- Subjects
- Biphenyl Compounds, Hedgehog Proteins therapeutic use, Humans, Pyridines, Antineoplastic Agents adverse effects, Carcinoma, Basal Cell drug therapy, Skin Neoplasms drug therapy
- 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., (Copyright © 2020 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.)
- Published
- 2021
- Full Text
- View/download PDF
8. Erythema Papulosa Semicircularis Recidivans: A New Entity or a Subtype of Erythema Annulare Centrifugum?
- Author
-
Bernia E, Requena C, and Llombart B
- Subjects
- Erythema diagnosis, Humans, Ascomycota, Skin Diseases, Genetic
- Published
- 2020
- Full Text
- View/download PDF
9. Conventional Photodynamic Therapy for Necrobiosis Lipoidica: Successful Treatment in a Series of 4 Cases.
- Author
-
Bernia E, Llombart B, Bancalari B, Diago A, and Serra-Guillén C
- Subjects
- Female, Humans, Photosensitizing Agents therapeutic use, Necrobiosis Lipoidica drug therapy, Photochemotherapy
- Abstract
Necrobiosis lipoidica is a rare chronic granulomatous disease. Multiple treatment approaches are available, but results are generally minimal and inconsistent. Some publications report variable results with photodynamic therapy (PDT) as a second line of treatment for refractory cases. We report 4 cases of necrobiosis lipoidica treated satisfactorily with conventional PDT using methyl aminolevulinate or 5-aminolevulinic acid BF-200 as the photosensitizing agent. All 4 patients were women with diabetes mellitus who had undergone treatment at least twice in the past, with little improvement. The lesions resolved completely with PDT, leaving only residual atrophy after a mean of 3.2 sessions per lesion., (Copyright © 2020 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.)
- Published
- 2020
- Full Text
- View/download PDF
10. Oral Contraceptives in Dermatology.
- Author
-
Requena C and Llombart B
- Subjects
- Ethinyl Estradiol adverse effects, Female, Humans, Levonorgestrel, Pregnancy, Progesterone, Contraceptives, Oral, Dermatology
- 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., (Copyright © 2020. Publicado por Elsevier España, S.L.U.)
- Published
- 2020
- Full Text
- View/download PDF
11. Functions of Dermatology Residents' Supervisors.
- Author
-
Medina S, Díaz R, Llombart B, García-Patos V, and Jaén P
- Subjects
- Clinical Competence, Dermatology education, Internship and Residency
- Published
- 2020
- Full Text
- View/download PDF
12. Parotid Fistula After Skin Biopsy: Treatment With Botulinum Toxin.
- Author
-
Bancalari B, Llombart B, Requena C, and Vendrell JB
- Subjects
- Aged, Biopsy adverse effects, Cutaneous Fistula etiology, Female, Fistula etiology, Humans, Parotid Diseases etiology, Photography, Sialorrhea drug therapy, Sialorrhea etiology, Botulinum Toxins, Type A therapeutic use, Cutaneous Fistula drug therapy, Fistula drug therapy, Parotid Diseases drug therapy, Parotid Gland pathology
- Published
- 2019
- Full Text
- View/download PDF
13. Diagnosis and Treatment of Merkel Cell Carcinoma in Specialized Dermatology Units: A Clinical Practice Guideline of the Spanish Academy of Dermatology and Venereology.
- Author
-
Vázquez Doval J, Llombart Cussac B, Pérez Bustillo A, Paradela de la Morena S, Fuente González MJ, Fernández Figueras MT, Villanueva MJ, Rodríguez Salas N, Descalzo-Gallego MÁ, García-Doval I, and Ríos-Buceta L
- Subjects
- Carcinoma, Merkel Cell pathology, Dermatology organization & administration, Evidence-Based Medicine, Hospital Departments, Hospital Units, Humans, Neoplasm Staging, Skin Neoplasms pathology, Spain, Carcinoma, Merkel Cell diagnosis, Carcinoma, Merkel Cell therapy, Skin Neoplasms diagnosis, Skin Neoplasms therapy
- 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 statementand 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., (Copyright © 2019 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.)
- Published
- 2019
- Full Text
- View/download PDF
14. The Rising Incidence of Merkel Cell Carcinoma.
- Author
-
Llombart B
- Subjects
- Humans, Incidence, Carcinoma, Merkel Cell epidemiology, Skin Neoplasms epidemiology
- Published
- 2019
- Full Text
- View/download PDF
15. Postirradiation Morphea in Patients With Breast Cancer: Possible Association With Other Autoimmune Diseases.
- Author
-
Diago A, Llombart B, Requena C, Sanmartín O, and Guillén C
- Subjects
- Aged, Female, Humans, Middle Aged, Autoimmune Diseases complications, Breast Neoplasms radiotherapy, Radiation Injuries complications, Scleroderma, Localized etiology
- Abstract
Postirradiation morphea is an uncommon entity that has been mostly described in women with breast cancer. The increasing use of radiotherapy to treat breast cancer and the clinical similarities between morphea and other conditions, such as radiodermatitis, postirradiation fibrosis, and tumor recurrence, highlights the need for dermatologists to be familiar with this entity. We present a series of 6 women with a mean age of 64.2 years and a mean latency of 9.5 years between radiotherapy for breast cancer and onset of morphea. Four of the patients had a history of autoimmune disease: rheumatoid arthritis, Sjögren syndrome, vitiligo, and Crohn disease. No specific risk factors for postirradiation morphea have been identified to date, although it would appear that a history of autoimmune disease could be associated with an increased risk of morphea in patients treated with radiation therapy., (Copyright © 2018 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.)
- Published
- 2019
- Full Text
- View/download PDF
16. Leiomyosarcoma and Pleomorphic Dermal Sarcoma: Guidelines for Diagnosis and Treatment.
- Author
-
Llombart B, Serra-Guillén C, Requena C, Alsina M, Morgado-Carrasco D, Machado I, and Sanmartín O
- Subjects
- Algorithms, Humans, Practice Guidelines as Topic, Leiomyosarcoma diagnosis, Leiomyosarcoma therapy, Sarcoma diagnosis, Sarcoma therapy, Skin Neoplasms diagnosis, Skin Neoplasms therapy
- Abstract
There are 3 types of leiomyosarcoma of the skin: dermal, subcutaneous, and metastatic cutaneous. Dermal leiomyosarcoma arises from smooth muscle fibers in arrector pili muscles, genital dartos muscles, and the nipple-areola complex. It is an intermediate-grade tumor associated with a tendency for local recurrence (24%) and low metastatic potential (4%). Subcutaneous leiomyosarcoma originates from smooth muscle in blood vessel walls and has higher rates of local recurrence (37%) and metastasis (43%). Plemorphic dermal sarcoma typically affects elderly patients and arises in sun-exposed areas (e.g., the scalp). Its histologic and immunohistochemical characteristics are similar to those of atypical fibroxanthoma, but it is more aggressive (metastasis rate of 10-20%). Histologically, it can be distinguished from atypical fibroxanthoma by the observation of subcutaneous tissue invasion, perineural invasion, and foci of necrosis., (Copyright © 2018 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.)
- Published
- 2019
- Full Text
- View/download PDF
17. Kaposi Sarcoma and Cutaneous Angiosarcoma: Guidelines for Diagnosis and Treatment.
- Author
-
Requena C, Alsina M, Morgado-Carrasco D, Cruz J, Sanmartín O, Serra-Guillén C, and Llombart B
- Subjects
- AIDS-Related Opportunistic Infections diagnosis, AIDS-Related Opportunistic Infections therapy, Age Distribution, Combined Modality Therapy, Female, Hemangiosarcoma pathology, Herpesvirus 8, Human isolation & purification, Humans, Lymphangiosarcoma diagnosis, Lymphangiosarcoma pathology, Lymphangiosarcoma therapy, Male, Neoplasms, Second Primary diagnosis, Neoplasms, Second Primary etiology, Neoplasms, Second Primary therapy, Radiotherapy adverse effects, Sarcoma, Kaposi classification, Sarcoma, Kaposi virology, Skin Neoplasms pathology, Skin Neoplasms virology, Hemangiosarcoma diagnosis, Hemangiosarcoma therapy, Practice Guidelines as Topic, Sarcoma, Kaposi diagnosis, Sarcoma, Kaposi therapy, Skin Neoplasms diagnosis, Skin Neoplasms therapy
- 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., (Copyright © 2018 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.)
- Published
- 2018
- Full Text
- View/download PDF
18. Guidelines for Diagnosis and Treatment of Cutaneous Sarcomas: Dermatofibrosarcoma Protuberans.
- Author
-
Llombart B, Serra C, Requena C, Alsina M, Morgado-Carrasco D, Través V, and Sanmartín O
- Subjects
- Antineoplastic Agents therapeutic use, Combined Modality Therapy, Dermatofibrosarcoma genetics, Dermatofibrosarcoma pathology, Humans, Imatinib Mesylate therapeutic use, Mohs Surgery, Neoplasm Grading, Neoplasm Staging, Oncogene Proteins, Fusion genetics, Radiotherapy, Adjuvant, Sarcoma classification, Sarcoma diagnosis, Sarcoma pathology, Sarcoma therapy, Skin Neoplasms genetics, Skin Neoplasms pathology, Dermatofibrosarcoma diagnosis, Dermatofibrosarcoma therapy, Practice Guidelines as Topic, Skin Neoplasms diagnosis, Skin Neoplasms therapy
- Abstract
Sarcomas comprise a broad group of tumors, many of whose biological behavior and aggressiveness differ from one type to another. The therapeutic approach is generally multidisciplinary and often complex. Developments in surgical and oncological dermatology during the last few decades have positioned dermatologists as specialists in the diagnosis and treatment of skin cancer. The aim of this article is to review the main soft tissue sarcomas that typically affect the skin. Dermatofibrosarcoma protuberans is a low-grade malignant sarcoma. It exhibits slow-growth, is locally invasive, and has low metastatic potential (<3%). Mohs micrographic surgery is the treatment of choice. The COL1A1-PDGFB translocation should be analyzed in cases of unclear diagnosis and when it is necessary to identify candidates for tyrosine kinase inhibitors. Imatinib is indicated for the treatment of locally advanced and metastatic dermatofibrosarcoma protuberans., (Copyright © 2018 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.)
- Published
- 2018
- Full Text
- View/download PDF
19. Experience With Vismodegib in the Treatment of Advanced Basal Cell Carcinoma at a Cancer Center.
- Author
-
Bernia E, Llombart B, Serra-Guillén C, Bancalari B, Nagore E, Requena C, Calomarde L, Diago A, Lavernia J, Traves V, Guillén C, and Sanmartín O
- Subjects
- Adult, Aged, Aged, 80 and over, Carcinoma, Basal Cell pathology, Female, Humans, Male, Middle Aged, Neoplasm Staging, Retrospective Studies, Skin Neoplasms pathology, Anilides therapeutic use, Carcinoma, Basal Cell drug therapy, Pyridines therapeutic use, Skin Neoplasms drug therapy
- Abstract
Introduction and Objectives: 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., Material and Methods: 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., Results: 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., Conclusions: 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., (Copyright © 2018 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.)
- Published
- 2018
- Full Text
- View/download PDF
20. A 12-Day Course of Imiquimod 5% for the Treatment of Actinic Keratosis: Effectiveness and Local Reactions.
- Author
-
Serra-Guillén C, Nagore E, Llombart B, Sanmartín O, Requena C, Calomarde L, and Guillén C
- Subjects
- Aged, Aged, 80 and over, Female, Humans, Imiquimod adverse effects, Interferon Inducers adverse effects, Male, Time Factors, Treatment Outcome, Imiquimod administration & dosage, Interferon Inducers administration & dosage, Keratosis, Actinic drug therapy
- Abstract
Introduction and Objectives: Imiquimod is an excellent option for patients with actinic keratosis, although its use may be limited by the long course of treatment required (4 weeks) and the likelihood of local skin reactions. The objectives of the present study were to demonstrate the effectiveness of a 12-day course of imiquimod 5% for the treatment of actinic keratosis and to examine the association between treatment effectiveness and severity of local reactions., Patients and Methods: We included patients with at least 8 actinic keratoses treated with imiquimod 5% cream for 12 consecutive days. Local reactions were classified as mild, moderate, or severe. The statistical analysis of the association between local reactions and clinical response was based on the Pearson χ
2 test and the Spearman rank correlation test., Results: Sixty-five patients completed the study. Complete response was recorded in 52.3% and partial response in 75.4%. We found a statistically significant association between severity of the local reaction and response to treatment in both the Pearson χ2 test and the Spearman rank correlation test., Conclusions: A 12-day course of imiquimod 5% proved effective for the treatment of actinic keratosis. Severity of local reactions during treatment was correlated with clinical response., (Copyright © 2017 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.)- Published
- 2018
- Full Text
- View/download PDF
21. Cutaneous Leiomyosarcoma: On the Importance of Histologic Location.
- Author
-
Llombart B
- Subjects
- Humans, Prognosis, Leiomyosarcoma, Skin Neoplasms
- Published
- 2018
- Full Text
- View/download PDF
22. Cutaneous Angiosarcoma: Clinical and Pathology Study of 16 Cases.
- Author
-
Requena C, Sendra E, Llombart B, Sanmartín O, Guillén C, Lavernia J, Traves V, and Cruz J
- Subjects
- Adult, Aged, Aged, 80 and over, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Breast Neoplasms pathology, Breast Neoplasms therapy, Cancer Care Facilities, Combined Modality Therapy, Early Detection of Cancer, Female, Follow-Up Studies, Head and Neck Neoplasms pathology, Head and Neck Neoplasms therapy, Hemangiosarcoma diagnosis, Hemangiosarcoma etiology, Hemangiosarcoma therapy, Humans, Lymphedema complications, Male, Middle Aged, Neoplasms, Radiation-Induced diagnosis, Neoplasms, Radiation-Induced etiology, Neoplasms, Radiation-Induced pathology, Neoplasms, Radiation-Induced therapy, Neoplasms, Second Primary diagnosis, Neoplasms, Second Primary pathology, Neoplasms, Second Primary therapy, Prognosis, Radiotherapy adverse effects, Radiotherapy, Adjuvant, Retrospective Studies, Skin Neoplasms diagnosis, Skin Neoplasms etiology, Skin Neoplasms therapy, Hemangiosarcoma pathology, Skin Neoplasms pathology
- Abstract
Introduction and Objectives: 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., Material and Methods: 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., Results: 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., Conclusions: 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., (Copyright © 2017 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.)
- Published
- 2017
- Full Text
- View/download PDF
23. Merkel Cell Carcinoma: An Update of Key Imaging Techniques, Prognostic Factors, Treatment, and Follow-up.
- Author
-
Llombart B, Kindem S, and Chust M
- Subjects
- Age of Onset, Aged, Aged, 80 and over, Antineoplastic Agents therapeutic use, Combined Modality Therapy, Female, Follow-Up Studies, Humans, Immunohistochemistry, Immunotherapy, Lymph Node Excision, Lymphatic Metastasis, Magnetic Resonance Imaging, Male, Middle Aged, Neoplasms, Radiation-Induced diagnostic imaging, Neoplasms, Radiation-Induced epidemiology, Neoplasms, Radiation-Induced pathology, Neoplasms, Radiation-Induced therapy, Positron Emission Tomography Computed Tomography, Prognosis, Radiotherapy, Adjuvant, Risk Factors, Sentinel Lymph Node Biopsy, Sunlight adverse effects, Tomography, X-Ray Computed, Treatment Outcome, Carcinoma, Merkel Cell diagnostic imaging, Carcinoma, Merkel Cell epidemiology, Carcinoma, Merkel Cell pathology, Carcinoma, Merkel Cell therapy, Skin Neoplasms diagnostic imaging, Skin Neoplasms epidemiology, Skin Neoplasms pathology, Skin Neoplasms therapy
- 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., (Copyright © 2016 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.)
- Published
- 2017
- Full Text
- View/download PDF
24. Update on Merkel Cell Carcinoma: Epidemiology, Etiopathogenesis, Clinical Features, Diagnosis, and Staging.
- Author
-
Llombart B, Requena C, and Cruz J
- Subjects
- Age of Onset, Aged, Chromosome Aberrations, Female, Follow-Up Studies, Genes, p53, Humans, Immunohistochemistry, Male, Merkel cell polyomavirus pathogenicity, Middle Aged, Neoplasm Staging, Neoplasms, Radiation-Induced diagnosis, Neoplasms, Radiation-Induced epidemiology, Neoplasms, Radiation-Induced etiology, Neoplasms, Radiation-Induced pathology, Polyomavirus Infections epidemiology, Prognosis, Risk Factors, Sunlight adverse effects, Tumor Virus Infections epidemiology, Carcinoma, Merkel Cell diagnosis, Carcinoma, Merkel Cell epidemiology, Carcinoma, Merkel Cell etiology, Carcinoma, Merkel Cell pathology, Skin Neoplasms diagnosis, Skin Neoplasms epidemiology, Skin Neoplasms etiology, Skin Neoplasms pathology
- Abstract
Merkel cell carcinoma (MCC) is a rare, highly aggressive tumor, and local or regional disease recurrence is common, as is metastasis. MCC usually develops in sun-exposed skin in patients of advanced age. Its incidence has risen 4-fold in recent decades as the population has aged and immunohistochemical techniques have led to more diagnoses. The pathogenesis of MCC remains unclear but UV radiation, immunosuppression, and the presence of Merkel cell polyomavirus in the tumor genome seem to play key roles. This review seeks to update our understanding of the epidemiology, etiology, pathogenesis, and clinical features of MCC. We also review histologic and immunohistochemical features required for diagnosis. MCC staging is discussed, given its great importance in establishing a prognosis for these patients., (Copyright © 2016 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.)
- Published
- 2017
- Full Text
- View/download PDF
25. Histologic Features Associated with Deep Invasion in Dermatofibrosarcoma Protuberans.
- Author
-
Serra-Guillén C, Llombart B, Nagore E, Guillén C, Requena C, Kindem S, Rivas N, Calomarde L, and Sanmartín O
- Subjects
- Humans, Neoplasm Invasiveness, Retrospective Studies, Dermatofibrosarcoma pathology, Skin Neoplasms pathology
- Abstract
Background: Dermatofibrosarcoma protuberans (DFSP) is a rare, slow-growing cutaneous tumor that can invade the subcutaneous tissue, muscle tissue, and even bone., Objective: To identify histologic features associated with greater depth of invasion, i.e., local aggressiveness, in DFSP., Material and Methods: 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., Results: 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%)., Conclusions: 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., (Copyright © 2016 AEDV. Published by Elsevier España, S.L.U. All rights reserved.)
- Published
- 2016
- Full Text
- View/download PDF
26. Small-cell neuroendocrine carcinoma, not Merkel cell carcinoma, in the sinonasal region: a case report.
- Author
-
Rivas-Tolosa N, Llombart B, Traves V, and Guillén C
- Subjects
- Adult, Carcinoma, Merkel Cell pathology, Diagnosis, Differential, Female, Humans, Carcinoma, Neuroendocrine pathology, Nose Neoplasms pathology, Skin Neoplasms pathology
- Published
- 2015
- Full Text
- View/download PDF
27. Paraneoplastic dermatomyositis: a study of 12 cases.
- Author
-
Requena C, Alfaro A, Traves V, Nagore E, Llombart B, Serra C, Martorell A, Guillén C, and Sanmartín O
- Subjects
- Adult, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Retrospective Studies, Dermatomyositis complications, Dermatomyositis diagnosis, Paraneoplastic Syndromes complications, Paraneoplastic Syndromes diagnosis
- Abstract
Introduction and Objectives: Adult dermatomyositis presents as a paraneoplastic syndrome in up to 25% of cases, but no clinical, histologic, or laboratory markers completely specific for paraneoplastic disease in dermatomyositis have been identified to date. Furthermore, studies on adult dermatomyositis do not usually report the frequency of cutaneous features of dermatomyositis in patients with associated cancer. Our aim was to review the characteristics of paraneoplastic dermatomyositis in patients seen at our hospital., Material and Methods: We studied 12 cases of paraneoplastic dermatomyositis and recorded patient age and sex, associated cancer, time between onset of dermatomyositis and cancer, emergent cutaneous manifestations, muscle involvement, dysphagia, lung disease, and levels of creatine phosphokinase and circulating autoantibodies., Results: The mean age of the patients was 61 years and the 2 most common malignancies were ovarian cancer and bladder cancer. The mean time between the diagnosis of cancer and dermatomyositis was 7 months and in most cases, the cancer was diagnosed first. Seven patients had amyopathic dermatomyositis. The most common cutaneous signs were a violaceous photodistributed rash sparing the interscapular area and a heliotrope rash, followed by Gottron papules and cuticle involvement. Superficial cutaneous necrosis was observed in 3 cases. Myositis-specific autoantibodies were not detected in any of the 6 patients who underwent this test., Conclusions: Paraneoplastic dermatomyositis is often amyopathic. There are no specific cutaneous markers for malignancy in dermatomyositis. Myositis-specific antibodies are not associated with paraneoplastic dermatomyositis., (Copyright © 2013 Elsevier España, S.L.U. y AEDV. All rights reserved.)
- Published
- 2014
- Full Text
- View/download PDF
28. Clinical presentation of acral lentiginous melanoma: a descriptive study.
- Author
-
Pereda C, Traves V, Requena C, Serra-Guillén C, Llombart B, Sanmartín O, Guillén C, and Nagore E
- Subjects
- Adult, Aged, Aged, 80 and over, Female, Foot, Hand, Humans, Male, Middle Aged, Retrospective Studies, Melanoma, Cutaneous Malignant, Melanoma pathology, Skin Neoplasms pathology
- Abstract
Background and Objective: Acral lentiginous melanomas -the melanomas most commonly found on the distal portions of the limbs- have usually reached more advanced stages than other types of melanoma when diagnosed. Our aim was to describe the clinical presentation of these tumors., Materials and Methods: Retrospective, descriptive, observational study of cases recorded in the database of the Instituto Valenciano de Oncología. In telephone interviews the patients answered a questionnaire on the presenting features of the lesion, on the presence of signs and symptoms included in the Glasgow 7-point checklist and the ABCDEs of melanoma, and on diagnostic delay attributable to patient or physician., Results: In the interviews with the 23 patients who responded to the questionnaire, we detected a diagnostic delay of more than 1 year attributable to the patient (delay in seeking care) in 30.4% of the cases. Diagnostic delay of more than 1 year attributable to the physician (failure to suspect the diagnosis) was identified in 20%. The most frequent reasons for consulting a physician about a lesion were changes in size, changes in color, bleeding, or failure to heal. In 20% of the cases the evaluating physician did not order histology for over a year., Conclusions: Diagnostic delay is a significant problem in acral lentiginous melanoma and may be attributable either to patients or to physicians' failure to recognize warning signs. Melanoma prevention campaigns should place more emphasis on the possibility of melanomas appearing on the palms and, particularly, on the soles., (Copyright © 2012 Elsevier España, S.L. and AEDV. All rights reserved.)
- Published
- 2013
- Full Text
- View/download PDF
29. Incipient merkel cell carcinoma: a report of 2 cases.
- Author
-
Requena C, Traves V, Llombart B, and Guillén C
- Subjects
- Aged, Aged, 80 and over, Female, Humans, Male, Carcinoma, Merkel Cell pathology, Skin Neoplasms pathology
- Abstract
Merkel cell carcinoma is a malignant skin tumor with a poor prognosis that primarily affects photoexposed areas of elderly patients. Tumor size is a very strong prognostic factor, with much better outcomes associated with small lesions, measuring less than 1cm. However, such lesions are rarely seen in the clinic in view of the rapid growth of this tumor. We report 2 cases of incipient Merkel cell carcinoma. Both cases of incipient Merkel cell carcinoma measured approximately 5mm in diameter. One tumor was confined to the epidermis and papillary dermis on the nose of a 79-year-old man and the other was located in the deep dermis, almost in the hypodermis, on the buttock of an 82-year-old woman. In both cases, the lesions had appeared weeks earlier. The first tumor seemed to originate in the dermoepidermal junction whereas the second originated almost in the hypodermis. Although the lesions were at a similar disease stage and had a similar size, their different locations within the dermis highlight once again the controversy about which cells give rise to Merkel cell carcinoma. The precursor cells could feasibly be Merkel cells in the first case but not in the second., (Copyright © 2011 Elsevier España, S.L. and AEDV. All rights reserved.)
- Published
- 2013
- Full Text
- View/download PDF
30. Dermatofibrosarcoma protuberans.
- Author
-
Serra-Guillén C, Llombart B, and Sanmartín O
- Subjects
- Humans, Immunohistochemistry, Dermatofibrosarcoma chemistry, Dermatofibrosarcoma pathology, Dermatofibrosarcoma therapy
- Abstract
Dermatofibrosarcoma protuberans is the most common skin sarcoma, although its incidence is very low compared with other skin tumors. It presents as a slow-growing indurated plaque on which nodules develop over time. The lesion arises in the dermis but can invade subcutaneous tissue, fascia, muscle and even bone. COL1A1-PDGFB translocation is specific to dermatofibrosarcoma protuberans, and the presence of this fusion contributes to diagnosis in certain cases. A review of the literature provides evidence that recurrence is much lower after Mohs micorgraphic surgery than after conventional wide local excision. In the case of metastatic disease or when surgery would be mutilating, another recently approved treatment is the tyrosine kinase inhibitor imatinib., (Copyright © 2011 Elsevier España, S.L. and AEDV. All rights reserved.)
- Published
- 2012
- Full Text
- View/download PDF
31. Conventional surgery compared with slow Mohs micrographic surgery in the treatment of lentigo maligna: a retrospective study of 62 cases.
- Author
-
Hilari H, Llorca D, Traves V, Villanueva A, Serra-Guillén C, Requena C, Llombart B, Sanmartín O, Guillén C, and Nagore E
- Subjects
- Aged, Aminoquinolines therapeutic use, Antineoplastic Agents therapeutic use, Combined Modality Therapy, Female, Head and Neck Neoplasms drug therapy, Head and Neck Neoplasms pathology, Humans, Hutchinson's Melanotic Freckle drug therapy, Hutchinson's Melanotic Freckle pathology, Imiquimod, Male, Middle Aged, Neoplasm Invasiveness, Neoplasm Recurrence, Local pathology, Neoplasm Recurrence, Local prevention & control, Neoplasm Recurrence, Local surgery, Neoplasm, Residual, Paraffin Embedding, Reoperation, Retrospective Studies, Skin Neoplasms drug therapy, Skin Neoplasms pathology, Skin Pigmentation, Treatment Outcome, Head and Neck Neoplasms surgery, Hutchinson's Melanotic Freckle surgery, Mohs Surgery methods, Skin Neoplasms surgery
- Abstract
Introduction: Surgical excision with margins of 0.5cm is the standard treatment for lentigo maligna (LM). Excision, however, is often incomplete as many of these tumors have indistinct borders., Objective: To identify clinical predictors of subclinical extension in primary and recurrent LM of the head and thereby determine which lesions might require wider surgical margins., Material and Methods: We reviewed the clinical records of patients with LM of the head treated definitively with conventional surgical excision or slow micrographic Mohs surgery (MMS) at the dermatology department of Instituto Valenciano de Oncología between January 1993 and April 2011., Results: Surgical margins larger than 0.5cm were required in 69.2% of recurrent LM and 26.5% of primary LM. Factors associated with the need for wider margins were prior treatment that might have interfered with the clinical delineation of the border, lesions in the center of the face, and skin phototypes III to V., Conclusions: Surgical margins of 0.5cm are inadequate for the treatment of a considerable number of LM lesions located on the head, particularly if these are recurrent. Slow MMS using paraffin-embedded sections appears to be the treatment of choice in such cases, particularly for recurrent lesions or lesions with poorly defined borders or possible subclinical extension., (Copyright © 2011 Elsevier España, S.L. y AEDV. All rights reserved.)
- Published
- 2012
- Full Text
- View/download PDF
32. [Mohs micrographic surgery for repeat excision of basal cell carcinomas on the head with positive margins].
- Author
-
Angulo J, Serra-Guillén C, Traves V, Botella-Estrada R, Sanmartín O, Llombart B, Requena C, Guillén C, and Nagore E
- Subjects
- Aged, Carcinoma, Basal Cell pathology, Disease Management, Facial Neoplasms pathology, Facial Neoplasms surgery, Female, Head and Neck Neoplasms pathology, Humans, Male, Middle Aged, Neoplasm Recurrence, Local pathology, Patient Selection, Reoperation statistics & numerical data, Scalp pathology, Skin Neoplasms pathology, Treatment Outcome, Carcinoma, Basal Cell surgery, Head and Neck Neoplasms surgery, Mohs Surgery statistics & numerical data, Neoplasm Recurrence, Local surgery, Scalp surgery, Skin Neoplasms surgery
- Abstract
Background: There is debate in the literature regarding the management of basal cell carcinoma following excision with positive surgical margins. While in some cases recurrence is not observed even after many years of follow-up, those in which recurrence does occur are at an increased risk of complications. Factors may exist that help to choose the best therapeutic approach for basal cell carcinomas on the head in which positive margins are observed following excision., Material and Methods: A total of 46 patients were selected who had been treated by Mohs micrographic surgery as a result of positive surgical margins being present following previous tumor excision. The factors associated with the absence of tumor nests and the occurrence of negative margins following a single Mohs stage were analyzed., Results: No associations were observed with sex, tumor size, affected margin (lateral, deep, or both), time since diagnosis, number of previous treatments, histological type, or tumor site. There was a certain trend towards more frequent identification of tumor nests when both surgical margins were affected and towards a requirement for a single Mohs stage in tumors less than 1.2 cm and in which less than 5 years had elapsed since diagnosis., Conclusions: Conclusive data are unavailable with which to define cases in which repeat excision is necessary or those in which conventional excision could be sufficient. The best option for the treatment of these tumors is Mohs micrographic surgery, although conventional excision could be reasonable in small tumors located at low-risk sites and in which long periods have not elapsed since diagnosis., (Copyright © 2010 Elsevier España, S.L. y AEDV. All rights reserved.)
- Published
- 2011
- Full Text
- View/download PDF
33. [Intralesional infusion of methotrexate as neoadjuvant therapy improves the cosmetic and functional results of surgery to treat keratoacanthoma: results of a randomized trial].
- Author
-
Martorell-Calatayud A, Requena C, Nagore E, Sanmartín O, Serra-Guillén C, Botella-Estrada R, Sanz-Motilva V, Llombart B, Alcañiz-Moscardo A, and Guillén-Barona C
- Subjects
- Aged, Aged, 80 and over, Antimetabolites, Antineoplastic administration & dosage, Combined Modality Therapy, Double-Blind Method, Esthetics, Facial Neoplasms drug therapy, Facial Neoplasms pathology, Facial Neoplasms surgery, Female, Hand, Humans, Injections, Intralesional, Keratoacanthoma pathology, Keratoacanthoma surgery, Male, Methotrexate administration & dosage, Middle Aged, Prospective Studies, Skin Neoplasms pathology, Skin Neoplasms surgery, Treatment Outcome, Tumor Burden, Antimetabolites, Antineoplastic therapeutic use, Keratoacanthoma drug therapy, Methotrexate therapeutic use, Neoadjuvant Therapy, Skin Neoplasms drug therapy
- Abstract
Background: Keratoacanthoma is currently considered to be an in situ squamous cell carcinoma that mainly affects patients over 70 years of age. The tumor has a good prognosis and, in some cases, can resolve spontaneously. Treatment involves simple excision. However, since the tumors generally occur on the face or extremities and display rapid growth, aggressive surgery may be required and the cosmetic results may be poor., Objective: The primary study objective was assessment of the efficacy of presurgical intralesional methotrexate infiltration to reduce the size of the tumor and the corresponding surgical defect., Material and Methods: A prospective, randomized study was undertaken in patients with a diagnosis of keratoacanthoma of at least 1.5 cm who were seen in our service between January 2009 and January 2010. Two groups were established: one receiving a single infiltration of methotrexate prior to surgery and another that did not receive methotrexate., Results: Of the 25 patients included in the study, 10 received neoadjuvant intralesional methotrexate (group A) and 15 underwent surgery without prior infiltration of methotrexate (group B). The patients in group A displayed a reduction of between 50% and 80% in the size of the lesion prior to surgery. No complications were observed either in relation to methotrexate infusion or surgery. In group B, only 1 patient had a slight reduction in the dimensions of the lesion prior to surgery. In the remaining cases, the lesions remained similar (4 cases, 26%) or had increased in size (10 cases, 66%) at the time of surgery. Five patients in this group required hospital admission following surgery., Conclusions: Neoadjuvant intralesional methotrexate is well tolerated and reduces the need for aggressive surgery in elderly patients with keratoacanthoma measuring more than 1.5 cm on the face or extremities., (Copyright © 2010 Elsevier España, S.L. y AEDV. All rights reserved.)
- Published
- 2011
- Full Text
- View/download PDF
34. [Increased risk of developing a second primary cutaneous nevus-associated melanoma in patients previously diagnosed with the disease].
- Author
-
Echeverría B, Botella-Estrada R, Serra-Guillén C, Martorell A, Traves V, Requena C, Sanmartín O, Llombart B, Guillén C, and Nagore E
- Subjects
- Adult, Aged, Burns epidemiology, Cell Transformation, Neoplastic, Female, Follow-Up Studies, Humans, Male, Melanocytes pathology, Melanoma genetics, Melanoma pathology, Middle Aged, Neoplasms, Second Primary genetics, Neoplasms, Second Primary pathology, Nevus, Pigmented genetics, Nevus, Pigmented pathology, Pigmentation, Retrospective Studies, Risk, Risk Factors, Skin injuries, Skin Neoplasms genetics, Skin Neoplasms pathology, Melanoma epidemiology, Neoplasms, Second Primary epidemiology, Nevus, Pigmented epidemiology, Skin Neoplasms epidemiology
- Abstract
Background: Patients diagnosed with primary cutaneous melanoma have a greater lifetime risk of developing further melanomas. Most of these melanomas appear to arise de novo, but a proportion of them develop in pre-existing melanocytic nevi., Objective: To determine risk factors associated with the development of a second cutaneous melanoma arising on a nevus in patients diagnosed with cutaneous melanoma., Patients and Methods: A series of 981 patients diagnosed with cutaneous melanoma was selected; 47 of them had been diagnosed with a second melanoma. These 47 patients were classified into 2 groups according to whether or not there was histological evidence that the melanoma was associated with a nevus., Results: Age at diagnosis less than 40 years, tumor location on the trunk, and superficial spreading subtype were independent risk factors for the appearance of a primary melanoma on a nevus. The only factor associated with the appearance of a second nevus-associated melanoma was that the first melanoma was also associated with a nevus (odds ratio, 9.51; 95% confidence interval 1.6-56.56; P=.042)., Conclusions: Nevus-associated melanomas develop mainly in young patients, on the trunk, and are of the superficial spreading subtype. A history of primary cutaneous melanoma arising on a nevus is associated with a 9-fold increase in the risk of developing a second nevus-associated melanoma. These findings highlight the need for careful follow-up of all melanocytic lesions in patients who have had a primary nevus-associated melanoma.
- Published
- 2010
35. [Chronic painless dactylitis as the initial finding in disseminated lung adenocarcinoma].
- Author
-
Martorell-Calatayud A, Llombart-Cussac B, Requena-Caballero C, and Guillén-Barona C
- Subjects
- Chronic Disease, Female, Humans, Middle Aged, Adenocarcinoma secondary, Lung Neoplasms pathology, Skin Neoplasms secondary, Thumb
- Published
- 2009
36. [Palmoplantar cutaneous reaction to sorafenib].
- Author
-
Echeverría B, Llombart B, Botella-Estrada R, and Guillén C
- Subjects
- Humans, Male, Middle Aged, Niacinamide analogs & derivatives, Phenylurea Compounds, Sorafenib, Antineoplastic Agents adverse effects, Benzenesulfonates adverse effects, Drug Eruptions etiology, Foot Dermatoses chemically induced, Hand Dermatoses chemically induced, Pyridines adverse effects, Skin Diseases, Vesiculobullous chemically induced
- Published
- 2009
37. [Microcystic adnexal carcinoma: Mohs micrographic surgery as the treatment of choice].
- Author
-
Martorell-Calatayud A, Requena-Caballero C, Botella-Estrada R, Almenar-Medina S, Sanmartín-Jiménez O, Llombart-Cussac B, Nagore-Enguídanos E, Serra-Guillén C, Echeverría-García B, and Guillén-Barona C
- Subjects
- Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Carcinoma surgery, Facial Neoplasms surgery, Mohs Surgery, Skin Neoplasms surgery
- 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
38. [Clinical and epidemiologic profile of melanoma patients according to sun exposure of the tumor site].
- Author
-
Nagore E, Botella-Estrada R, Requena C, Serra-Guillén C, Martorell A, Hueso L, Llombart B, Sanmartín O, and Guillén C
- Subjects
- Adult, Aged, Female, Humans, Male, Melanoma pathology, Middle Aged, Retrospective Studies, Skin Neoplasms pathology, Melanoma diagnosis, Melanoma epidemiology, Skin Neoplasms diagnosis, Skin Neoplasms epidemiology, Sunlight adverse effects
- Abstract
Introduction: Melanomas arising in areas with comparable levels of sun exposure have been shown to have similar genetic profiles. The aim of this study was to characterize the clinical features of melanoma patients according to the pattern of sun exposure: chronic, intermittent, or none., Material and Methods: From our melanoma database, we selected 789 consecutive patients with melanoma diagnosed in our center since January 2000. Epidemiologic data, phenotype, and personal and family history of cancer were retrieved. The observed frequency of each variable was compared., Results: Most melanoma patients presented tumors on areas exposed intermittently to sunlight. In addition, these patients presented higher numbers of common and atypical melanocytic nevi and the melanoma very frequently arose in a pre-existing nevus. The second largest group was formed by patients with tumors on areas chronically exposed to sun and that had all the clinical lesions (solar lentigines and actinic keratoses) and epidemiological characteristics typical of these areas. Finally, patients with melanomas on areas not exposed to sun were older, as occurred in the group with chronic exposure, and the diagnosis was made at more advanced stages of the disease., Conclusions: There are many patients who did not fit these patterns of melanoma development. Clinical and biological characterization is therefore necessary to determine alternative pathways of development in order to establish specific preventive measures.
- Published
- 2009
39. [Proliferative cutaneous epithelioid angiomatous nodule].
- Author
-
Requena Caballero C, Nicolau MJ, Haro R, Martorell A, Sanmartín O, Llombart B, Botella R, Guillén C, and Requena L
- Subjects
- Adult, Angiomatosis, Bacillary diagnosis, Diagnosis, Differential, Facial Neoplasms diagnosis, Female, Hemangioendothelioma, Epithelioid diagnosis, Hemangioma diagnosis, Hemangiosarcoma diagnosis, Humans, Male, Pregnancy, Pregnancy Complications, Neoplastic diagnosis, Shoulder, Skin Neoplasms diagnosis, Facial Neoplasms pathology, Hemangioma pathology, Pregnancy Complications, Neoplastic pathology, Skin Neoplasms pathology
- Abstract
The cutaneous epithelioid angiomatous nodule is an uncommon benign vascular proliferation that has only recently been described. Clinically, it usually presents as a solitary, fast-growing, small reddish papulous or nodular lesion on the trunk or limbs of adults. Histopathologic study reveals a proliferation of epithelioid cells and predominantly solid, well delimited, unilobular growth in the superficial dermis. Well defined vessels are often found permeating the lesion, which also shows a certain degree of inflammatory infiltration. The cells contain abundant pink cytoplasm, often with vacuoles, and vesicular nuclei with prominent nucleoli. The morphology of these cells is relatively uniform, without atypia or pleomorphism, although mitoses are not uncommon. We report 2 new cases of cutaneous epithelioid angiomatous nodules, the first in a 28-year-old pregnant woman and the second in a 27-year-old man. In both cases, the usual characteristics of this entity were present, but with the peculiarity of a high mitotic index. We discuss the differential diagnosis of cutaneous epithelioid angiomatous nodules with other vascular proliferations that exhibit epithelioid cytology.
- Published
- 2009
40. [Chemotherapy-induced acral erythema: a clinical and histopathologic study of 44 cases].
- Author
-
Hueso L, Sanmartín O, Nagore E, Botella-Estrada R, Requena C, Llombart B, Serra-Guillén C, Alfaro-Rubio A, and Guillén C
- Subjects
- Humans, Drug Eruptions etiology, Erythema chemically induced, Foot Dermatoses chemically induced, Hand Dermatoses chemically induced
- Abstract
Introduction: Acral erythema, also known as palmoplantar erythrodysesthesia or hand-foot syndrome, is a relatively common cutaneous reaction caused by a variety of chemotherapeutic agents. It presents during cancer treatment as painful erythema and paresthesia affecting the palms and soles. It seems to be dose dependent and its appearance is determined by both the peak plasma concentration and the cumulative dose of the chemotherapeutic agent. The symptoms and histopathology findings are suggestive of direct cytotoxicity affecting the epidermis of the extremities caused by high concentrations of chemotherapeutic agents. The most commonly implicated agents are doxorubicin, 5-fluoracil and its derivatives, cytarabine, and docetaxel., Material and Methods: We present the clinical and histologic characteristics of a series of patients diagnosed with chemotherapy-induced acral erythema. The study included all patients who developed acral erythema lesions following chemotherapy between January 2000 and December 2003., Results and Conclusions: Out of 2186 patients who underwent chemotherapy, 44 cases of acral erythema were identified, representing an incidence of 2.01 % during the study period and 16.75 % of all cutaneous lesions attributed to chemotherapy. The most commonly implicated drug was 5-fluoracil administered by continuous infusion and the highest incidence was observed in patients treated with liposomal doxorubicin. Acral erythema was a dose-limiting toxic effect in 29.5 % of cases. The histologic findings varied according to the clinical severity of the lesions and included interface dermatitis with variable keratinocyte necrosis, dilation of the superficial vascular plexus, and limited inflammatory infiltrate. The most commonly used treatment was pyridoxine, along with topical treatments such as cold compresses, emollients, and topical corticosteroids.
- Published
- 2008
41. [Stewart-Bluefarb syndrome].
- Author
-
Hueso L, Llombart B, Alfaro-Rubio A, Serra-Guillén C, Requena C, González M, Cano B, Nagore E, Sanmartín O, Botella-Estrada R, and Guillén C
- Subjects
- Adult, Arteriovenous Fistula complications, Humans, Leg Dermatoses etiology, Male, Syndrome, Arteriovenous Fistula diagnosis, Leg Dermatoses diagnosis
- 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
- Full Text
- View/download PDF
42. [Oral involvement in lymphomatoid papulosis].
- Author
-
Serra-Guillén C, Requena C, Alfaro A, Hueso L, Sanmartín O, Llombart B, Nagore E, Botella-Estrada R, Martorell-Calatayud A, and Guillén C
- Subjects
- Aged, Clobetasol therapeutic use, Eosinophilia drug therapy, Eosinophilia pathology, Humans, Lymphomatoid Papulosis drug therapy, Male, Methotrexate therapeutic use, Prednisone therapeutic use, Tongue Diseases drug therapy, Tongue Diseases pathology, Ulcer drug therapy, Ulcer pathology, Eosinophilia etiology, Lymphomatoid Papulosis pathology, Mouth Mucosa pathology, Tongue Diseases etiology, Ulcer etiology
- Abstract
Lymphomatoid papulosis is a cutaneous lymphoma with an indolent clinical behaviour characterized by chronic development of recurrent, self-limited lesions appearing as necrotic papules and with a pathology compatible with T cell lymphoma. Mucosal involvement by lymphomatoid papulosis is very rare but has been reported in the literature. It usually appears as ulcers in patients previously diagnosed of lymphomatoid papulosis. From a histological perspective it is characterized by an infiltrate of CD 30 positive atypical lymphocytes together with a mixed inflammatory infiltrate of eosinophils, neutrophils, histiocytes and plasma cells. We report the case of a man previously diagnosed of lymphomatoid papulosis that developed two ulcerated lesions in the tongue whose biopsy confirmed the diagnosis of oral involvement by lymphomatoid papulosis.
- Published
- 2007
43. [Behçet's disease and periarteritis nodosa with cutaneous lesions].
- Author
-
Serra-Guillén C, Llombart B, Alfaro-Rubio A, Hueso L, Martorell-Calatayud A, Requena C, Nagore E, Botella-Estrada R, Sanmartín O, and Guillén C
- Subjects
- Adult, Behcet Syndrome diagnosis, Diagnosis, Differential, Disease Progression, Erythema Nodosum diagnosis, Female, Humans, Polyarteritis Nodosa diagnosis, Polyarteritis Nodosa pathology, Recurrence, Stomatitis, Aphthous etiology, Ulcer etiology, Vulvar Diseases etiology, Behcet Syndrome complications, Polyarteritis Nodosa etiology
- Published
- 2007
44. [Dermatofibrosarcoma protuberans].
- Author
-
Sanmartín O, Llombart B, López-Guerrero JA, Serra C, Requena C, and Guillén C
- Subjects
- Antigens, CD34 analysis, Antineoplastic Agents therapeutic use, Benzamides, Biomarkers, Tumor analysis, Chemotherapy, Adjuvant, Chromosomes, Human, Pair 17 ultrastructure, Chromosomes, Human, Pair 22 genetics, Chromosomes, Human, Pair 22 ultrastructure, Combined Modality Therapy, Dermatofibrosarcoma chemistry, Dermatofibrosarcoma classification, Dermatofibrosarcoma drug therapy, Dermatofibrosarcoma genetics, Dermatofibrosarcoma pathology, Dermatofibrosarcoma surgery, Drug Design, Humans, Imatinib Mesylate, Mohs Surgery, Neoadjuvant Therapy, Neoplasm Invasiveness, Neoplasm Proteins analysis, Neoplasm Proteins genetics, Neoplasm Recurrence, Local, Oncogene Proteins, Fusion analysis, Oncogene Proteins, Fusion genetics, Piperazines therapeutic use, Prognosis, Pyrimidines therapeutic use, Receptor, Platelet-Derived Growth Factor beta antagonists & inhibitors, Ring Chromosomes, Sarcoma chemistry, Sarcoma drug therapy, Sarcoma genetics, Sarcoma pathology, Sarcoma surgery, Skin Neoplasms chemistry, Skin Neoplasms drug therapy, Skin Neoplasms genetics, Skin Neoplasms surgery, Translocation, Genetic, Skin Neoplasms pathology
- 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
- Full Text
- View/download PDF
45. [Giant dermatofibroma: case report and review of the literature].
- Author
-
Hueso L, Sanmartín O, Alfaro-Rubio A, Serra-Guillén C, Martorell A, Llombart B, Requena C, Nagore E, Botella-Estrada R, and Guillén C
- Subjects
- Histiocytoma, Benign Fibrous surgery, Humans, Male, Middle Aged, Remission Induction, Shoulder, Skin Neoplasms surgery, Histiocytoma, Benign Fibrous pathology, Skin Neoplasms pathology
- Abstract
Dermatofibroma is a very frequent lesion that usually appears as a slowly growing nodule in the dermis, and preferentially involves the lower extremities of women. Several clinical variants have been described. Giant dermatofibroma has been defined as a rare variant of dermatofibroma measuring more than 5 cm that presents typical histological features and a benign biological behavior. We report the case of a 52-year-old man that presented a giant dermatofibroma with a diameter of 6 cm in the right shoulder and we review the few cases of this variant that have been described in the literature.
- Published
- 2007
46. [Benign epithelioid fibrous histiocytoma].
- Author
-
Alfaro-Rubio A, Botella-Estrada R, Calatrava A, Requena C, Serra-Guillén C, Hueso L, Martorell A, Sanmartín O, Nagore E, Llombart B, and Guillén C
- Subjects
- Adult, Biomarkers, Tumor analysis, Biopsy, Diagnosis, Differential, Factor XIIIa analysis, Histiocytoma, Benign Fibrous chemistry, Histiocytoma, Benign Fibrous diagnosis, Humans, Male, Melanoma, Neoplasm Proteins analysis, Neoplasms, Second Primary chemistry, Neoplasms, Second Primary diagnosis, Skin Neoplasms chemistry, Skin Neoplasms diagnosis, Vimentin analysis, Histiocytoma, Benign Fibrous pathology, Neoplasms, Second Primary pathology, Skin Neoplasms pathology
- Published
- 2007
- Full Text
- View/download PDF
47. [Adenoid cystic carcinoma].
- Author
-
Alfaro-Rubio A, Sanmartín Jiménez O, Serra-Guillén C, Requena Caballero C, Hueso Gabriel L, Botella-Estrada R, Nagore Enguídanos E, Llombart Cussac B, and Guillén Barona C
- Subjects
- Aged, Carcinoma, Adenoid Cystic radiotherapy, Carcinoma, Adenoid Cystic surgery, Humans, Lip pathology, Lip surgery, Lip Neoplasms radiotherapy, Lip Neoplasms surgery, Male, Treatment Outcome, Carcinoma, Adenoid Cystic pathology, Lip Neoplasms pathology
- Abstract
Adenoid cystic carcinoma is an uncommon tumor of the head and neck. Although it is mainly located in the salivary gland, a skin location has also been described. Metastases are rare, but 50 % of the cases relapse. A 65-year-old male patient had a lesion in the upper lip. After resection, the histological diagnosis was adenoid cystic carcinoma. Treatment was completed with radiotherapy. Ten years later, a nodule was detected in the neck. Its histological diagnosis was lymphatic metastasis due to adenoid cystic carcinoma. Primary cutaneous adenoid cystic carcinoma is a very uncommon tumor in which treatment consists in extensive local excision with free margins. Radiotherapy is not curative and should be reserved for palliative treatments. Multicenter, prospective studies are necessary to determine the best treatment and especially the adjuvant treatment for adenoid cystic carcinoma.
- Published
- 2006
- Full Text
- View/download PDF
48. [Multiple post-chemotherapy plantar nevi].
- Author
-
Hueso L, Requena C, Serra-Guillén C, Alfaro A, Nagore E, Llombart B, Botella-Estrada R, Sanmartín O, and Guillén C
- Subjects
- Child, Female, Foot Diseases pathology, Humans, Nevus, Pigmented pathology, Precursor Cell Lymphoblastic Leukemia-Lymphoma drug therapy, Skin Neoplasms pathology, Antineoplastic Agents adverse effects, Foot Diseases chemically induced, Nevus, Pigmented chemically induced, Skin Neoplasms chemically induced
- Abstract
The induction of multiple melanocytic nevi in children after chemotherapy has been documented in the literature. This situation apparently has more to do with the state of immunosuppression that is produced than with any specific agent used. We present the case of a 12-year-old girl who presented with multiple plantar melanocytic nevi after multidrug chemotherapy for acute lymphocytic leukemia. None of the lesions showed any alarming clinical signs. Although the degeneration of post-chemotherapy melanocytic nevi to melanoma has not been documented in any of the cases described, the presence of a high number of melanocytic nevi is an accepted risk factor for melanoma; thus, close clinical follow-up of these patients seems advisable.
- Published
- 2006
- Full Text
- View/download PDF
49. [Analysis of the COL1A1-PDGFB fusion gene in a case of dermatofibrosarcoma protuberans with a fibrosarcoma component].
- Author
-
Llombart B, Sanmartín O, López-Guerrero JA, Monteagudo C, Calabuig S, Botella R, Nagore E, Requena C, Guillén C, Cremades A, Pellín A, and Llombart-Bosch A
- Subjects
- Adult, Arm, Dermatofibrosarcoma pathology, Female, Fibrosarcoma pathology, Humans, Skin Neoplasms pathology, Dermatofibrosarcoma genetics, Fibrosarcoma genetics, Oncogene Proteins, Fusion genetics, Skin Neoplasms genetics
- Abstract
Dermatofibrosarcoma protuberans (DFSP) is an infrequent tumor of intermediate malignancy, with little tendency to develop metastases but with a high rate of local recurrence. Cytogenetically, DFSP is characterized by a reciprocal translocation, t(17;22)(q22;q13), which is a conditioning factor in the fusion of the collagen type I alpha I gene (COL1A1) in chromosome 17q with the platelet-derived growth factor beta chain gene (PDGFB) in chromosome 22q. The fusion of these genes is variable, involving one of the 51 exons of the COL1A1 gene and exon 2 of the PDGFB gene. We present the case of a 37-year-old woman with a tumor on the arm whose histology showed a neoplastic infiltration of the subcutaneous cellular tissue made up of fusiform cells with an elongated nucleus in a storiform pattern and other more pleomorphic cells in a herringbone pattern, compatible with DFSP with a fibrosarcoma component. The molecular biology study with RT-PCR analysis of paraffin-embedded material and later sequencing showed a new fusion of exon 19 of the COL1A1 gene and exon 2 of PDGFB, supporting a diagnosis of DFSP. A study of the COL1A1-PDGFB fusion products is useful in cases where histology and immunohistochemistry are insufficient for the differential diagnosis of DFSP versus other sarcomas. It also justifies the use of new avenues of treatment with tyrosine kinase inhibitors.
- Published
- 2006
- Full Text
- View/download PDF
50. [Extravasation of cytostatic agents: a serious complication of oncological treatment].
- Author
-
Alfaro-Rubio A, Sanmartín O, Requena C, Llombart B, Botella-Estrada R, Nagore E, Serra-Guillén C, Hueso L, and Guillén C
- Subjects
- Adult, Aged, Antidotes therapeutic use, Antineoplastic Agents administration & dosage, Biopsy, Debridement, Drug Eruptions drug therapy, Drug Eruptions pathology, Drug Eruptions prevention & control, Drug Eruptions surgery, Extravasation of Diagnostic and Therapeutic Materials drug therapy, Extravasation of Diagnostic and Therapeutic Materials pathology, Extravasation of Diagnostic and Therapeutic Materials prevention & control, Extravasation of Diagnostic and Therapeutic Materials surgery, Female, Hand Dermatoses chemically induced, Hand Dermatoses epidemiology, Hand Dermatoses pathology, Humans, Incidence, Infusions, Intravenous, Irritants administration & dosage, Irritants adverse effects, Male, Middle Aged, Neoplasms complications, Neoplasms drug therapy, Panniculitis chemically induced, Panniculitis pathology, Panniculitis surgery, Retrospective Studies, Vinblastine administration & dosage, Vinblastine adverse effects, Vinblastine analogs & derivatives, Vinorelbine, Antineoplastic Agents adverse effects, Drug Eruptions epidemiology, Extravasation of Diagnostic and Therapeutic Materials epidemiology
- Abstract
The extravasation of cytostatic agents is a known, serious situation that can easily occur and cause chronic, irreversible damage. The incidence of extravasation ranges from 0.1 %-6.5 %, according to different studies. Many cases of extravasation can be prevented by systematizing the administration techniques for cytostatic agents. We present the clinical and histological characteristics of a series of patients with extravasation lesions. Included in the study were all patients treated with chemotherapy who developed localized lesions in the area of the cytostatic injection after extravasation was detected during administration. The patients were studied and followed up for a three-year period, from January 2000 to December 2003, inclusive. We found nine cases of extravasation among the 2,186 patients who were treated with chemotherapy, which represents an incidence of 0.41 %, and 3.4 % of all chemotherapy-induced skin lesions. The cytostatic agent most often involved was vinorelbine, and the most frequent location was the antecubital fossa. The intensity of the lesions made it necessary to delay the next cycle of treatment in 55 % of the cases. The histological findings varied depending on when the biopsy was done, showing panniculitis with low cellularity together with epidermal lesions attributable to direct cytotoxicity. The best treatment for extravasation is prevention, but when it has already occurred, measures vary depending on the cytostatic drug extravasated and the intensity of the lesions. Conservative measures are advisable before surgery.
- Published
- 2006
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.