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Introduction: Keratoacanthoma (KA) is a group of tumors of epidermal origin with controversial nature. Subungual keratoacanthoma (SUKA) is a rare and destructive variant with more aggressive behavior. SUKA appears as a rapidly growing, painful tumor beneath the nail plate that rapidly progresses to a mass that can measure up to 2 cm. The toe location is unusual. The diagnosis must be made based on the correlation of clinical, radiological, and histopathological findings. Case Presentation: We present two cases of patients diagnosed with SUKAs with different clinical presentations which ranged from very typical to uncommon one. Both cases were treated with simple excision without recurrences. Conclusion: SUKA is a rare subungual tumor. Nail bed location represents a more difficult diagnostic challenge. SUKA should be suspected in the context of persistent and progressive pain on a finger or toe, once more frequent painful tumors have been ruled out.

A cross-sectional pilot study was conducted in acute leukemia adult patients in order to characterize oral mucosal conditions in acute leukemia, and to analyze their association with certain clinical, nutritional and laboratory parameters. Oral evaluation was performed. Epidemiologic, clinical and laboratory data were considered. Statistical analysis included non-parametric tests and multivariate analysis. A total of 30 patients (60% males) were included; median age of 39 (range 17-62) years old. The median percentage of caloric intake adequacy was 96.8% (range 21.8-205.7%), and the median ideal weight was 117.9% (range 88.2-162.9%). The most common oral mucosal findings were pallor and furred tongue. Leukoedema was seen only in patients 30 years old. Exfoliative cheilitis was more frequent in females [OR=2.7 (CI=1.2-6.1); p=0.02] and in patients with high β-carotene concentrations [Md= 94.5 vs 57.0 µg/dl; (p=0.01)]. Higher rates of diffuse hyperpigmentation were seen (p

Introduction: Tuberous sclerosis complex (TSC) is a genetic multisystem disorder with prominent skin involvement. Multiple ungual fibromas, also known as Koenen tumors (KTs), are one of the major diagnostic criteria and occur approximately in 50% of patients with TSC. They are disfiguring, painful, and challenging to treat as they frequently recur. There are 2 previous cases in the literature of KTs as the only clinical sign of TSC. Case Presentation: A 56-year-old male patient with intellectual disability presented with a history of ungual growths that had gradually increased in size and number for 20 years. The diagnosis of KTs was established on clinical grounds, without the requirement of histological confirmation. No additional clinical evidence of TSC was found. Complete surgical excision of the tumors located in the proximal nail matrix, periungual folds, and nail bed of each toe was successfully performed. Discussion: The association between KTs and intellectual disability with TSC supported the clinical diagnosis. To date, there is no standard first-line treatment for KTs. Complete surgical excision up to the proximal base of the tumor offers satisfactory results in terms of functionally and esthetic appearance and could be considered the preferred therapeutic modality for patients with severe functional and cosmetic impairment. Prompt recognition of the many signs and symptoms associated with TSC is important to achieve early diagnosis, preventing further complications.

Syphilis is an infectious disease caused by the spirochete Treponema pallidum, transmitted mainly by direct contact with the lesion. Primary syphilis usually presents with a chancre at the site of infection, which is highly contagious and resolves without treatment. The aim of this article is to illustrate an unusual location of a syphilitic chancre, in order to consider this diagnosis within the approach to patients with oral ulcers.a 30-year-old man who presented a dermatosis located in the left labial commissure, characterized by a painless ulcer of 1 cm in diameter of 20 days of evolution. The patient has a history of HIV/AIDS. A punch biopsy of the dermatosis was performed, with a histopathological report compatible with syphilitic chancre and a negative VDRL result. He was treated with penicillin G benzathine showing improvement.Primary syphilis is characterized by the development of the syphilitic chancre, which is the first manifestation of syphilis in up to 60% of cases. Extragenital presentation is rare, with only 12-14% of all cases, and of these between 40-70% occur in the mouth, being the lips the most frequent location. Oral manifestations can represent a diagnostic challenge due to its wide spectrum of clinical presentations.la sífilis es una enfermedad infecciosa causada por la espiroqueta Treponema pallidum, transmitida principalmente por contacto directo con la lesión. La sífilis primaria generalmente se presenta con un chancro en el sitio de la infección, el cual es altamente contagioso y se resuelve sin tratamiento. El objetivo de este trabajo es ilustrar una localización poco común de un chancro sifilítico, ya que conocer la existencia de presentaciones poco frecuentes permitirá favorecer su sospecha al abordar las causas de úlceras orales.hombre de 30 años de edad, el cual presenta una dermatosis localizada en la comisura labial izquierda, caracterizada por una úlcera no dolorosa de 1 cm de diámetro de 20 días de evolución. El paciente tiene antecedente de VIH/SIDA. Se realizó biopsia en sacabocados de la dermatosis, siendo el informe histopatológico compatible con chancro sifilítico y resultado de VDRL negativo. Fue tratado con penicilina G benzatínica, con lo que presentó mejoría.la sífilis primaria se caracteriza por la aparición del chancro sifilítico, el cual es la primera manifestación de la sífilis hasta en el 60% de los casos. La presentación extragenital es rara, con solo un 12-14% de todos los casos y, de estos, entre un 40-70 % se presentan en la boca, siendo los labios la localización más frecuente. Las manifestaciones orales pueden representar un desafío diagnóstico debido a su amplio espectro de presentaciones clínicas.

espanolAntecedentes: El penfigo vulgar (PV) se caracteriza por la presencia de autoanticuerpos contra las desmogleinas 1 y 3 y da lugar a la formacion de ampollas epidermicas. El fundamento para usar la plasmaferesis terapeutica (PT) es retirar los autoanticuerpos patogenicos; este procedimiento se considera un tratamiento de tercera linea. Objetivo: Analizar el papel de la PT en pacientes con PV que no responden al tratamiento convencional y su efecto a largo plazo en la dosis de prednisona. Material y metodos: Analisis retrospectivo de una serie de casos de seis pacientes con PV sometidos a PT entre 2011 y 2015. Se registraron los datos demograficos, condiciones medicas, dosis de inmunosupresores iniciales y posteriores a la PT, numero de sesiones de PT y efectos adversos relacionados con la PT. Se comparo la dosis de prednisona antes de la PT y seis meses despues. Resultados: La media de superficie corporal afectada fue de 54%. Antes de la PT, todos los pacientes recibieron corticosteroides sistemicos (al menos 1 mg/kg/dia) e inmunosupresores sin adecuada respuesta. La media de sesiones de PT por paciente fue de tres y el tiempo medio para la reepitelizacion fue 10 dias. No se registraron efectos adversos graves relacionados con la PT. A los seis meses, todos los pacientes mostraron una reduccion significativa de la dosis de prednisona (p = 0.0413), con una media de reduccion de la dosis de 40 mg/dia. Conclusiones: La PT es un procedimiento seguro y efectivo en el tratamiento de casos resistentes, acelera la respuesta clinica y puede contribuir a la reduccion a largo plazo de la dosis de prednisona. EnglishBackground: Pemphigus vulgaris (PV) is characterized by the presence of autoantibodies against desmoglein 1 and 3 with resulting formation of epidermal blisters. The rationale for using therapeutic plasma exchange (TPE) is the removal of pathogenic autoantibodies, this procedure is considered a third-line treatment. Objective: The objective of the study was to analyze the role of plasmapheresis in PV patients that do not respond to conventional therapy and its long-term effect of prednisone dose. Materials and methods: We performed a retrospective analysis of a case series of six PV patients who underwent TPE from December 2011 to October 2015. We recorded demographic data, pre-existing medical conditions, immunosuppressant doses taken before and after TPE, number of TPE sessions, and adverse events related to TPE. We compared the prednisone dose before TPE and 6 months later. Results: The median affected body surface area at the time of admission was 54%. Before TPE, all the patients were receiving systemic corticosteroids (at least 1 mg/kg/day) and had received other immunosuppressants without adequate response. The median number of TPE sessions received by each patient was 3, and the median time to reepithelization after starting TPE was 10 days. No serious adverse events related to TPE were registered. At the 6-month follow-up, all the patients experienced significant reduction in the absolute prednisone dose (p = 0.0413), with a median reduction in prednisone dosage of 40 mg/days. Conclusion: TPE is a safe procedure that has been proved effective in the treatment of refractory cases of PV, it accelerates clinical response and it can contribute in the long-term dose reduction of prednisone.

The aim of this study was to translate into Mexican Spanish, cross‐culturally adapt and validate the wound‐specific quality of life (QoL) instrument Cardiff wound impact schedule (CWIS) for Mexican patients. This instrument went through the full linguistic translation process based on the guidelines of Beaton et al (Beaton DE, Bombardier C, Guillemin F, Ferraz MB, Guidelines for the process of cross‐cultural adaptation of self‐report measures, Spine Phila Pa, 1976, 2000, 318‐391). We included a total of 500 patients with chronic leg ulcers. The expert committee evaluated the Face validity and they agreed unanimously that the instrument was adequate to assess the QoL of these patients, covering all relevant areas presented by them. The content validity index obtained was of 0.95. The construct validity demonstrated moderately significant correlations between related sub‐scales of CWIS and SF‐36 (P = .010 to P

The onycholemmal horn is an exceedingly rare subungual tumor characterized by trichilemmal-like keratinization pattern. The only previous instance of onycholemmal horn dates back to 1983 when Haneke reported a keratotic subungual tumor clinically and histologically comparable to a trichilemmal horn. No other case of this condition has been reported so far. We present the case of a 72-year-old female patient, with a history of a slowly growing tumor originating from the nail bed epithelium of the left thumb. The lesion was surgically removed, and pathological examination was consistent with the diagnosis of an onycholemmal horn. Additionally, this study aims to elucidate the correlation between the onycholemmal and trichilemmal keratinization.

A man, age 45 years, was diagnosed with intermediate-risk stage IV clear cell renal carcinoma (lung and lymph node metastases). He was prescribed first-line systemic treatment with sunitinib (Sutent) 50 mg per day (each cycle: 4 weeks on, 2 weeks off). Upon day 22 of his second sunitinib cycle, he came to the oncology clinic complaining of difficulty walking due to bilateral sole pain. He described initial tingling sensations, which then became burning and painful, with symmetrical erythema and edema of the soles, without blisters. These turned into painful plaques with yellowish discoloration and hyperkeratosis on pressure-bearing areas. He denied fever or other symptoms. The pain limited his instrumental activities of daily living, but not his self-care activities of daily living. Total body skin examination disclosed hyperkeratotic plaques on the undersurface of the great toes and heels of both feet, predominantly at sites of pressure; no blisters, crusts, ulcers, or fissures were found. No relevant findings were found upon physical examination of his hands, mucosae, and scalp. A diagnosis of grade 2 hand-foot skin reaction (HFSR) was made.

Introduction. Systemic lupus erythematosus (SLE) is an autoimmune disease that includes a broad spectrum of mucocutaneous manifestations. Objectives. To characterize the clinical spectrum of oral mucosal lesions in patients with SLE and to analize their association with clinical and laboratory parameters. Methods. We performed a cross-sectional study with systematic oral evaluations in SLE adult patients. Systemic and cutaneous lupus activities were recorded. We collected epidemiologic, clinical, and laboratory data. Statistical analysis included the kappa coefficient, X2 test, Fisher’s exact test and Mann-Whitney U-test, adjusting for multiple comparisons according to Bonferroni’s method. Results. A total of 181 patients (92.8% females) were included, with a median age of 37 (range 16-76) years. Cutaneous, systemic, and oral manifestations of lupus erythematosus (LE) activity were found in 31.5%, 23.8% and 18.8% of patients, respectively. Higher titres of anti-double-stranded (ds) DNA antibodies were detected in patients with LE-related oral lesions (LEOL) when compared to those without LEOL [356 (82-1083) UI vs 45 (0-417) UI; p=0.02). LEOL did not correlate to cutaneous (k=0.380) nor systemic (k=0.228) LE-activity (p Conclusions. Oral manifestations related to SLE were significantly associated to anti double-ds DNA antibodies. LEOL were independent of cutaneous and systemic activity.

BACKGROUND: The infection by coronavirus disease 2019 (COVID-19) has been associated with multiple cutaneous manifestations, although characterization of them in Hispanic patients with darker skin phototypes is lacking. The objective of this study is to characterize the clinical dermatological manifestations associated with COVID-19 infection in cases with few or without general symptoms in patients from Latin America. METHODS: Cross-sectional study using a questionnaire that was made for health professionals (physicians with a specialty in dermatology) to investigate dermatological lesions associated with COVID-19 infection in patients from 25 countries of Latin America. The survey was active from June 9 to July 30, 2020. RESULTS: In this study, information was collected from a total of 347 patients. We found a female gender predominance: 179/347 (51.6%). The mean age at presentation was 40.87 years. The most frequent dermatological manifestations were maculopapular rash and urticarial lesions, followed by papulovesicular lesions, vesicular lesions, chilblain-like lesions, papular lesions, ecchymosis, petechial purpura, pityriasis rosea-like lesions, pruritus, palmoplantar dysesthesias, transient livedo, acral necrosis, palpable purpura, livedo racemosa, and retiform purpura. As far as we know, there are no previous reports of pruritus and palmoplantar dysesthesias. CONCLUSIONS: This registry emphasizes skin manifestations as an important criterion for establishing the diagnosis of COVID-19 infection in Latin American countries. This information will be useful for the early identification of suspected cases by health professionals (dermatologists and nondermatologists) and will allow contact tracing to mitigate the impact on health systems at different levels

espanolLa vitamina D es una provitamina liposoluble de la hormona esteroidea 1,25- hidroxivitamina D3 sintetizada en los queratinocitos, producida por via endogena ante la exposicion a los rayos ultravioleta o por via exogena mediante suplementacion. La produccion de la vitamina D esta determinada por el fototipo de Fitzpatrick, el sexo, el indice de masa corporal y los polimorfismos en el receptor de vitamina D. En epocas anteriores, la vitamina D era considerada una hormona con funcion exclusivamente relacionada con el metabolismo y la homeostasis del calcio. En la actualidad, ha sido vinculada con diversas patologias de caracter neoplasico, autoinmune, cardiovascular y dermatologico. En el area de la Dermatologia, la alteracion de la vitamina D desempena un papel esencial en la etiopatogenia de diferentes dermatosis de caracter inflamatorio y neoplasicas, se encuentra relacionada con la gravedad de presentacion, pronostico a corto y largo plazo, asi como recurrencia de estas. Por lo tanto, conocer las principales dermatosis relacionadas con la alteracion en la regulacion inmunitaria de la vitamina D es de suma importancia para el manejo y posible suplementacion como tratamiento coadyuvante de la enfermedad. Consideramos que la suplementacion de vitamina D es util para mantener la homeostasis celular de la piel. EnglishVitamin D is a liposoluble provitamin of the steroid hormone 1,25-hydroxyvitamin D3 synthesized in keratinocytes, produced by the endogenous route when exposed to UV rays or exogenously by means of supplementation. The production of vitamin D is determined by Fitzpatrick’s phototype, gender, body mass index and polymorphisms in the vitamin D receptor. Previously, it was considered a hormone with function exclusively related to the calcium metabolism and homeostasis. Currently, the role of the hormone has been linked to an increasing number of neoplastic, autoimmune, cardiovascular and dermatological diseases. In Dermatology, altered vitamin D plays an essential role in pathogenesis of different inflammatory and neoplastic dermatoses, it is related to severity, short and long-term prognosis, as well as recurrence of the disease. Therefore, knowing the main dermatological diseases related to altered immune regulation of vitamin D is of utmost importance for the management and possible supplementation as an adjuvant treatment. We consider that Vitamin D supplementation is useful maintaining cell homeostasis of the skin.

Dysregulation in the expression of microRNAs (miRNAs), single-stranded RNAs which regulate gene expression, has been associated with diseases such as Stevens–Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN), although their cellular origin has not been explored. Thus, the focus of this work was to study expression patterns of reported miRNAs involved in T-cell activation following drug-specific stimulation in peripheral blood mononuclear cells (PBMCs) and drug-specific CD4+ T-cell clones (TCC) from patients with different cutaneous manifestations of delayed-type drug hypersensitivity reactions. CD4+ T-cells from hypersensitive patients were stimulated to proliferate, secreted cytokines (IFN-γ and IL-22), cytolytic molecules (Granzyme B) and up-regulate miRNAs 24 to 48 h after drug exposure. Carbamazepine-specific CD4+ T-cells that proliferated to the greatest extent and secreted the highest levels of IFN-γ showed an up-regulation of miR-18a and miR-155. In contrast, piperacillin-specific CD4+ T-cell...

Resumen Antecedentes El carcinoma de piel no melanoma basocelular y el carcinoma epidermoide o espinocelular (CEC) son tumores frecuentes. El carcinoma basocelular es el cancer mas frecuente y el menos agresivo; en algunas ocasiones, a pesar del tratamiento quirurgico con margenes amplios, un porcentaje bajo tiene comportamiento agresivo, como invasion local extensa, recurrencias y metastasis. El CEC tiene un comportamiento mas agresivo, primero en piel, despues en ganglios linfaticos y, raramente, con metastasis a otros organos. Objetivo Identificar las caracteristicas de los CEC recurrentes y la frecuencia de aparicion de nuevos tumores, tras el tratamiento quirurgico con cirugia convencional y cierre diferido de herida hasta obtener el resultado histologico libre de tumor (transoperatorio tardio), esto con la finalidad de tener mejores opciones de tratamiento en la poblacion mexicana. Material y metodo Se revisaron los expedientes de 10 anos y se incluyeron aquellos que tenian diagnostico de CEC. Resultados Se incluyeron 114 tumores en 103 pacientes. Utilizando un analisis descriptivo, se encontro que la media de diagnostico de casos nuevos por ano fue 32.2. Pacientes masculinos 48 (46.6%) y 55 (53.4%) femeninos. La edad diagnostica fue entre 19 y 91 anos (media = 71.94; DE = 13.34) con un tiempo de evolucion de 1 a 112 meses (media = 12 meses; DE = 2.65). El mas frecuente es en la mejilla y la variedad histologica invasiva se da en el 54%. En 14 pacientes se encontro un segundo CEC. Solo tuvimos 4 recurrencias, que aparecieron entre el primer y el cuarto ano de seguimiento, y 3 de estos fueron tratados con cirugia con transoperatorio tardio. Conclusion Este estudio demostro que la tecnica de cirugia con transoperatorio tardio es adaptable para el tratamiento de CEC con buenos resultados y bajo porcentaje de recurrencia en un seguimiento a 10 anos.

Introduction Surgery is performed more frequently now at days, due to the increasing incidence of melanoma and no-melanoma skin cancer. There are different opinions among dermatologic surgeons between to continue or discontinue antithrombotic therapy prior to the procedure, which increases the risk of thromboembolic events. Prophylaxis with oral antibiotics in the postsurgical period is controversial. Objective To report the safety of surgery without suspending antithrombotic therapy and without oral antibiotic prophylaxis in dermatology surgery of patients with multiple comorbidities and polypharmacy. Method We designed a retrospective study. We included a total of 655 patients; 96.6% had at least one comorbidity; 27.7% used aspirin and 4.3% some type of antithrombotic therapy. The most common type of skin tumor was basal cell carcinoma with 69.8% . Results The complication rate was 4.2%; the most was wound dehiscence (1.1%), followed by partial necrosis (0.9%), infection (0.9%), reaction to foreign body (0.6%), complete necrosis (0.3%), bleeding (0.2%) and fistulae (0.2%). Conclusions Based on the literature and our experience, dermatologic surgery is safe without suspending antithrombotic therapy or antibiotic prophylaxis in patients with multiple comorbidity.

Background: Scalp involvement is not directly evaluated in patients with dermatomyositis (DM). Therefore, the exact frequency of scalp dermatomyositis (SDM) and its clinical and trichoscopic characteristics have been poorly described. Objective: The aim of this study was to determine the frequency and clinical and dermoscopic features of SDM in patients diagnosed with DM. Methods: We performed a descriptive prospective, cross-sectional observational study that included all patients diagnosed with DM at a Mexican academic institute over the course of a year. Results: Twenty-four out of 31 patients with DM had scalp involvement at clinical examination, with a prevalence of 77.4%. SDM was clinically characterized by erythema in all cases, scales in 20 (83.3%) patients, nonscarring alopecia in 21 (87.5%) patients, pruritus in 17 (70.8%) patients, and poikiloderma of the scalp in 16 (51.6%) patients. Twenty-eight patients were evaluated by trichoscopy. The most consistent finding was the presence of enlarged capillaries, found in 20 (71.4%) cases, followed by peripilar casts (57.1%) and tufting and interfollicular scales in 14 (50%) cases. Twenty-two patients also had positive nail fold capillaroscopic features similar to those observed by trichoscopy. Limitations: The simple size was limited. Conclusions: Scalp involvement and alopecia are common in patients with DM, and trichoscopy shows features similar to those found at capillaroscopy. Trichoscopy is a very important tool for diagnosis of scalp involvement in patients with DM.

Foreign modelling agent reactions (FMAR) are the result of the injection of unapproved high-viscosity fluids with the purpose of cosmetic body modelling. Its consequences lead to ulceration, disfigurement and even death, and it has reached epidemic proportions in several regions of the world. We describe a series of patients treated for FMARs in a specialised wound care centre and a thorough review of the literature. A retrospective chart review was performed from January 1999 to September 2015 of patients who had been injected with non-medical foreign agents and who developed cutaneous ulceration needing treatment at the dermatology wound care centre. This study involved 23 patients whose ages ranged from 22 to 67 years with higher proportion of women and homosexual men. The most commonly injected sites were the buttocks (38·5%), legs (18%), thighs (15·4%) and breasts (11·8%). Mineral oil (39%) and other unknown substances (30·4%) were the most commonly injected. The latency period ranged from 1 week to 17 years. Complications included several skin changes such as sclerosis and ulceration as well as systemic complications. FMAR is a severe syndrome that may lead to deadly complications, and is still very common in Latin America.

Surgery is performed more frequently now at days, due to the increasing incidence of melanoma and no-melanoma skin cancer. There are different opinions among dermatologic surgeons between to continue or discontinue antithrombotic therapy prior to the procedure, which increases the risk of thromboembolic events. Prophylaxis with oral antibiotics in the postsurgical period is controversial.To report the safety of surgery without suspending antithrombotic therapy and without oral antibiotic prophylaxis in dermatology surgery of patients with multiple comorbidities and polypharmacy.We designed a retrospective study. We included a total of 655 patients; 96.6% had at least one comorbidity; 27.7% used aspirin and 4.3% some type of antithrombotic therapy. The most common type of skin tumor was basal cell carcinoma with 69.8% .The complication rate was 4.2%; the most was wound dehiscence (1.1%), followed by partial necrosis (0.9%), infection (0.9%), reaction to foreign body (0.6%), complete necrosis (0.3%), bleeding (0.2%) and fistulae (0.2%).Based on the literature and our experience, dermatologic surgery is safe without suspending antithrombotic therapy or antibiotic prophylaxis in patients with multiple comorbidity.La cirugía es uno de los procedimientos que se realizan con mayor frecuencia en dermatología debido a la mayor incidencia de cáncer de piel melanoma y no melanoma. Se han encontrado distintas posturas entre los cirujanos dermatólogos sobre continuar o suspender antiagregantes y anticoagulantes antes del procedimiento, lo cual incrementa el riesgo de eventos tromboembólicos, además de la preferencia de utilizar profilaxis antibiótica de forma posquirúrgica por algunos dermatólogos.Reportar nuestra experiencia en cuanto a la seguridad de la cirugía dermatológica sin la suspensión de anticoagulantes/antiagregantes y sin profilaxis antibiótica en pacientes con múltiple comorbilidad y polifarmacia.Se revisaron 655 pacientes. El 96.6% tenían al menos otra enfermedad. El 27.7% utilizaba ácido acetilsalicílico y el 4.3% algún tipo de anticoagulante. El tipo de neoplasia más frecuente fue el carcinoma basocelular con 69.8%.La tasa total de complicaciones fue del 4.2%. La complicación más frecuente fue la dehiscencia de la herida (1.1%), seguida de la necrosis parcial (0.9%), la infección (0.9%), la reacción a cuerpo extraño (0.6%), la necrosis total (0.3%), la hemorragia (0.2%) y la fístula cutánea (0.2%).Basándonos en la literatura y nuestra experiencia, la cirugía dermatológica es segura sin suspender antitrombóticos ni indicar profilaxis antibiótica en pacientes con múltiple comorbilidad.

Cutaneous metastasis is a rare event occurring most frequently in patients previously diagnosed with cancer. However, subungual metastases are even less frequent. The most common neoplasms associated with the latter are lung, kidney, and breast neoplasms. Lung cancer is the main cause of subungual metastases in the fingers, and genitourinary tract tumors are the main cause of subungual metastases in the toes. This is the first case report of an adenocarcinoma of the prostate with subungual metastasis.

Subungual melanoma represents 20% of all melanomas in Hispanic population. Here, we report the outcome of 15 patients with in situ subungual melanoma treated with resection of the nail unit with a 5-mm margin without amputation, followed up for 55.93 ± 43.08 months. The most common complications included inclusion cysts and nail spicules. We found no evidence of local or distant recurrences at the last visit of our follow up. Functional outcome was good, with only one patient reporting persistent mild pain. These results support functional, non-amputative surgical management of in situ subungual melanomas.

Leukemia Cutis (LC) consists in neoplastic leukocytic infiltration of the skin and is strongly associated with the presence of extramedullary disease and poor prognosis. However, there are few studies in the literature regarding this entity. We perform a retrospective study of 27 mexican patients in order to analyze the clinical features and prognosis of LC in Mexico, and a brief review of the literature.Cases diagnosed as LC by skin biopsy were selected from the database of the Department of Dermatology of National Institute of Medical Science and Nutrition Salvador Zubirán. Cases were searched between the dates of January 1993 and December 2013.Twenty-seven cases which were histologically confirmed with cutaneous leukemic infiltrate were included. Of these patients 60% were male and the mean age at diagnosis was 42 yr (19 to 80 yr). The predominant tipe of LC was acute myeloid leukemia (AML) with 48% of the cases. Nodular neoformations were the main clinical manifestation with 63% of the cases. The mean interval between the diagnosis of LC and death was 10 months (CI 95%).The presence of LC is a marker of poor prognosis and can precede the relapse of systemic leukemia. Cutaneous infiltration may be the first or the only sign of progression, so doctors should be familiar with the clinical manifestations of this disease.

Introduction Non-melanoma skin cancer is the most common malignancy worldwide. Differentiating between malignant and benign skin tumors, however, can be challenging. As a result, various auxiliary tools have been developed to aid in the diagnosis of cutaneous neoplasms. Here, skin tumors were investigated through analysis of their digital image histograms and spectroscopic response under ultraviolet (UV) and white light-emitting diodes (LEDs). Methods Fifty tumoral lesions were spectroscopically and histologically studied. For optical studies, UV at 375 nm and white LEDs were used to illuminate the lesions. Commercial cameras were used for imaging, and a miniature spectrometer with a bifurcated optical fiber was used for spectroscopic measurements. Results In this study, the intensity histograms of the images taken under white and UV illumination and the spectroscopic response under white light showed clear differences between pigmented basal cell carcinoma (BCC), intradermal melanocytic nevus (IDN), and melanoma lesions for skin phototypes III and IV. However, there was little difference in their spectroscopic response to the UV LED. Conclusion We found differences in the intensity and shape of diffuse reflectance spectra of pigmented BCC, IDN, and melanoma lesions in patients with skin phototypes III and IV. Also, images taken under UV and white light were helpful for differentiation of these pigmented lesions. Additional research is needed to ascertain the clinical utility of these tools for skin cancer diagnosis.

Background Non-melanoma skin cancer includes basal cell carcinoma and squamous cell carcinoma (SCC). Basal cell carcinoma is the most common and least aggressive but in a low percentage of cases, despite appropriate wide surgical margins, it can be aggressive, producing local invasion, recurrences and distance metastasis. SCC has a more aggressive behaviour invading first the skin, the lymph nodes and less frequently produces distance metastasis. Objective To identify the characteristics of recurrent SCC and frequency of new SCC after conventional surgical and primary closure or closure delayed until a histological reporting of tumour-free surgical margins, in order to achieve a better surgical option, in our Mexican population. Materials and method We reviewed clinical records from the last 10 years, and included those with a diagnosis of SCC. Results One hundred and fourteen tumours in 103 patients were included. The mean new tumour diagnosis was 32.2 per year; there were 46.6% men and 53.4% women. Age range 19–91, with mean 71.94 years (SD = 13.34). The evolution time was from 1 to 112 months (mean = 12 months, SD = 2.65). The most affected site was the cheek. In addition, an invasive tumour was reported in 54% in the histopathological study. At 10-year follow-up we found a second SCC in 14 patients and only 4 recurrences, between the 1st and 4th year and 3 were treated with delayed closure until margins were tumour-free. Conclusion In this study we demonstrated that delayed closure technique is easy and adaptable in our population in the treatment of SCC, achieving good results with very low recurrences at 10-year follow-up.

Foreign modelling agent reactions (FMAR) are the result of the injection of unapproved high‐viscosity fluids with the purpose of cosmetic body modelling. Its consequences lead to ulceration, disfigurement and even death, and it has reached epidemic proportions in several regions of the world. We describe a series of patients treated for FMARs in a specialised wound care centre and a thorough review of the literature. A retrospective chart review was performed from January 1999 to September 2015 of patients who had been injected with non‐medical foreign agents and who developed cutaneous ulceration needing treatment at the dermatology wound care centre. This study involved 23 patients whose ages ranged from 22 to 67 years with higher proportion of women and homosexual men. The most commonly injected sites were the buttocks (38·5%), legs (18%), thighs (15·4%) and breasts (11·8%). Mineral oil (39%) and other unknown substances (30·4%) were the most commonly injected. The latency period ranged from 1 week to 17 years. Complications included several skin changes such as sclerosis and ulceration as well as systemic complications. FMAR is a severe syndrome that may lead to deadly complications, and is still very common in Latin America.

Spondyloarthritis comprises a group of inflammatory rheumatic disorders with a genetic predisposition involving multiple genes that interact with environmental factors. The skin manifestations of spondyloarthritis are diverse, particularly psoriatic arthritis related to the overexpression of inflammatory cytokines such as TNF, IL-6, IL-12, IL-2 and IFN-γ; this psoriatic dermatitis is a common skin feature of spondyloarthritis. Spondyloarthritis mainly affects the spine, sacroiliac joints, ligaments and other tissues. Psoriatic lesions are erythematous plaques covered with silvery whitish scales distributed on the scalp, elbows, knees, trunk and gluteus creases, and the fingernails are frequently involved. Individuals with reactive arthritis and Crohn’s disease may exhibit psoriasiform dermatitis and other manifestations including ocular inflammation, oral ulceration, erythema nodosum and/or thrombophlebitis. In the case of reactive arthritis, male patients may exhibit circinate balanitis and keratoderma b...

Perineurioma is an infrequent and benign cutaneous neoplasm characterized by proliferation of perineurial cells. It is classified into two main types: intraneural and the extraneural or soft tissue perineurioma, in which the sclerosing variant is included. Sclerosing perineurioma is more frequently found on acral skin. Clinically, they are well-circumscribed,skin colored, nodular tumors.Describe and communicate clinicopathologic findings from a case series of sclerosing acral perineurioma.This is a clinical, morphological and immunohistologic case study of eight patients with the diagnosis of sclerosing perineurioma.It included five men and five women, with ages ranging between nine and 66 years. All of them had lesion on acral skin. At microscopy study, the lesions showed a proliferation of epithelioid and spindle-shaped perineurial cells, arranged in small aggregates and short fascicles between thickened collagen bundles. Immunohistochemistry studies revealed that the proliferating cells expressed EMA, Claudin-1 and Glut-1, and were negative for S-100 protein.It is important to report these infrequent skin tumors, so they can be taken into account in the differential diagnoses of acral lesions.

Pachydermoperiostosis, which occurs more frequently in men, is a rare entity with distinctive clinical features and an insidious onset.. We report the case of a 30-year-old man with a one-year history of acropachy, arthralgias, hiperhidrosis, and progressive skin thickening of the face and scalp. The radiological findings were consistent with periostosis and the histopathological analysis from a facial skin biopsy showed a pandermal increase in the thickness and number of collagen bundles. The pathogenesis of PDP is currently unknown, although an increased secretion of prostaglandin E2 (PGE2), which stimulates the overexpression of vascular endothelial growth factor (VEGF), has been suggested as a major factor. No specific treatment exists; however, in most cases, the disease tends to stabilize over time.

Non-melanoma skin cancer (NMSC) is the most common malignancy in transplant patients. The incidence of basal cell carcinoma (BCC) is 10 times greater than in the general population, while squamous cell carcinoma (SCC) is 100 times greater. The relationship between the BCC and SCC reverses and increases according to the degree of immunosuppression and sun exposure. One way to predict the risk of NMSC should be based on factors such as: total sun burden factor (TSB).To determine the influence of various risk factors in the development of NMSC and its relation to the type and duration of immunosuppressive treatment, type of transplant, and TSB.We worked with a fledgling historical cohort in which patients with kidney or liver transplant were identified and recorded if they developed some form of skin cancer. To study the factors associated with NMSC, we resorted to the strategy of a case-control study. Dermatological examination was performed and a questionnaire of risk factors made in both groups.Of the 140 patients enrolled, 51 were women and 89 men, 120 were renal transplant recipients and 20 liver transplants. Of patients who developed NMSC, 100% were renal transplant recipients. The median age was 48.5 years. Most cancer patients worked outdoors. A total of 78 lesions were found in 40 NMSC patients, 59 (76%) of them were SCC, and 19 (24%) BCC; 45% of all skin cancer patients had more than one injury. The worst affected areas were those photoexposed: 60% head and neck, trunk and upper extremities 18% 50%. In 30% of patients (12/40) 22 new tumors were identified (SCC 18 and BCC 4). No lesions were identified for melanoma. In multivariate logistic regression analysis, statistically significant features were: type-based immunosuppressive regimen of cyclosporine A, azathioprine and prednisone (OR: 59.7; 95% CI: 10.2-348), TSB10 (OR: 19; 95% CI: 3-120) and duration of use of immunosuppressive therapy (OR: 1.06; 95% CI: 0.9-1.1). The mean time from transplantation to first dermatological assessment was six years (+5.4). Of the patients, 93% had not regularly used sunscreen before and after transplantation.The dermatological assessment is convenient and easy to perform. Primary prevention, close monitoring, diagnosis, and treatment of skin lesions are essential components of a comprehensive program for the evaluation of transplant recipients, the purpose of which is to reduce the incidence and morbidity associated with cancer.

We report a 21-year-old farmer with a 4-year history of a nodular plaque with fistulas and induration of adjacent skin. The lesion had been treated surgically at another hospital, but recurred 2 years later. Black, charcoal-like grains were observed draining through the fistulas. A biopsy specimen showed brown grains with filaments in an abscess surrounded by macrophages, giant cells, and lymphocytes. Culture demonstrated small white colonies of Madurella mycetomatis. The patient was treated with itraconazole for 6 months, followed by surgery. TNP was initiated in the immediate post-operative period, and copious granulation tissue was observed within 1 week. Autologous skin grafting was performed, and itraconazole was continued for an additional 3 months. Although necrosis of the graft ensued, the functional result was acceptable. The patient appeared free of disease at 18 months of follow-up. Eumycotic mycetoma is an infectious and inflammatory process that occurs after traumatic inoculation of fungi through the skin. Surgery is the treatment of choice, but successful reconstruction may be challenging and recurrence is common. Topical negative pressure (TNP) promotes the formation of granulation tissue, which facilitates closure of deep wounds and chronic ulcers. This case illustrates that eumycotic mycetoma is difficult to treat. Whether TNP contributed to the successful outcome cannot be proven but, given the generally poor response of eumycetoma to therapy, we suggest that the role of TNP in the management of this disease merits attention.

At the beginning of the nineteen-eighties, vulvar vestibular papillomatosis (VVP) was thought to be a human papilloma virus (HPV) disease. Based upon these findings many clinicians have been treating this condition with laser ablation or by topical application of podophyllin or trichloroacetic acid. Currently, most authors believe that VVP should be considered an anatomical variant of the vestibular mucosa and not HPV related. We present a case of VVP in which there was no histological or molecular evidence of HPV; unnecessary treatment should be avoided.

Patients with cat cry or “cri-du-chat” syndrome often present with hallmark signs of the condition. The purpose of this manuscript is to report the findings observed in skin and oral mucosa which produced high morbidity in a 19 year-old female patient with cat cry syndrome, considering the scarce descriptions of the lesions on these anatomical sites. Nutritional, neurological and dermatological manifestations are described; laboratory findings are also included. The impact of clinical findings on inadequate nutritional status of patient is discuss. The approach is emphasized in order to improve the intraoral diagnoses, management and quality of life of this patient.

Background: Nonmycosis fungoides/Sezary syndrome (non-MF/SS) primary cutaneous lymphomas (PCL) are currently categorized under the 2005-World Health Organization/European Organization for Research and Treatment of Cancer (WHO-EORTC) classification for PCL. These differ in behavior from secondary cutaneous lymphomas (SCL) and to lymphomas limited to the oral cavity (primary oral lymphomas [POL]) both categorized under the 2016-WHO classification for lymphoid neoplasms. Aims: This study aims to report the first series of non-MF/SS PCL, SCL, and POL in a Mexican cohort, examine the applicability of current classification systems and compare our findings with those from foreign cohorts. Materials and Methods: Eighteen non-MF/SS PCL, four SCL, and two POL with available tissue for morphology and immunophenotypic assessment were reclassified according to the 2005-WHO/EORTC and 2016-WHO classifications. Results: Non-MF/SS PCLs were primarily of T-cell origin (61%) where CD30+ lymphoproliferative disorders predominated, followed by Epstein–Barr virus-induced lymphomas, and peripheral T-cell lymphomas, not otherwise specified. Primary cutaneous B-cell lymphomas (BCL) were primarily of follicle center cell origin followed by postgerminal lymphomas of the diffuse large BCL variety. Conclusions: Most non-MF/SS PCL, SCL, and POL can be adequately categorized according to the 2005-WHO/EORTC and 2016-WHO classification systems, even when dealing with clinically atypical cases. The relative frequencies in our cohort hold closer similarities to Asian registries than from those of Europe/USA, supporting the concept of individual and/or racial susceptibility, and the notion of geographical variances in the rate of lymphomas. In particular, such disparity may arise from viral-induced lymphomas which might show partial geographical restriction.

A 33-year-old man with chronic heart failure secondary to dilated cardiomyopathy who developed pneumonia during his stay in the intensive care unit (ICU), was started on subcutaneous nadroparin (2850 UI subcutaneously, once a day) as prophylaxis against venous thromboembolism. By day 7, he had developed a heart-shaped blistering skin lesion with central necrosis and surrounding erythaema at the nadroparin injection site (figure 1). Throughout his stay, laboratory tests revealed neither thrombocytopaenia nor evidence of systemic thrombosis; but despite this unusual presentation, we clinically suspected a high probability of type II heparin-induced thrombocytopaenia (HIT) and a score of 6 points according to the 4T's HIT …

Melanoma is a type of tumor that arises from melanocytes generally located in the dermoepidermal junction. Although melanoma is found in less than 10% of cases, mortality is high representing 75% of deaths attributed to cutaneous cancer. There are four major subtypes: Superficial spreading melanoma, lentigo malignant melanoma, acral lentiginous melanoma and nodular melanoma. Superficial spreading melanoma is the most common type among Caucasians. In a Mexican case series, the nodular type is the most common type reported. The aim of this study was to determine the most common type seen at our medical facility.We analyzed patient's medical records from March 1981 to December 2006. Demographic data included sex, age, place of residence, occupation, tumor progression, location and clinical description. Histologically we evaluated tumor thickness using the Breslow scale; invasion was measured using the Clark scale. This is a descriptive, cross-sectional and retrospective study.165 patients were studied, 112 were females and 53 males. The most common location was the lower limb. Acral lentiginous melanoma was the most common subtype.Our findings differ from the other series where they report nodular and superficial spreading melanoma as the most common types. The most common subtypes in our study were acral lentiginous melanoma and lentigo malignant melanoma among females, with a ratio of female-male of 2.1:1.

Confluent and reticulated Gougerot-Carteaud papillomatosis is an uncommon dermatological condition that affects adolescents, especially young women with dark skin types. It presents itself as asymptomatic pigmented patches with a papillomatous texture that coalesce to form reticular plaques localized in the neck and intertriginous areas. The cause of this disease is unknown, although an abnormal keratinization has been implicated and sometimes has been associated with Malassezia sp. It has a chronic course with remissions and exacerbations. Several therapies have been used unsuccessfully to eradicate it but nowadays there is no specific treatment. We report a case treated efficiently with minocycline without recurrence at 6 months follow-up.

Benign skin neoplasms are defined as autonomous growing tissue unrelated to normal growing of the skin, that persist even after the originating stimulus dissapears. Almost all human beings have a certain number of benign cutaneous neoplasms and many never seek medical attention. There is a dearth of information regarding the frequency of these tumors. The aim of this study was to record the number of benign tumors studied at the Dermatology Department of a medical facility.A retrospective study analyzed medical records between 2000 and 2006. We included year of admission, number of biopsies, sex, age, tumor location, histological and clinical diagnoses.We analyzed 9,436 biopsies of which 3,765 constituted benign neoplasms; 595 were not included and our total sample was 3,170 tumors. The most frequent tumors according to histopathological diagnoses in descending order were: melanocytic, cutaneous cysts, fibrous tumors, vascular tumors, epidermal tumors, fat tumors, tumors with hair differentiation, neural tumors, glandular tumors, tumors with sebaceous differentiation, cartilage and bone tumors, and smooth muscle tumors. The most common benign tumors were: Melanocytic nevi, epidermal cysts, seborrheic keratoses, pyogenic granulomas, lipomas and dermatofibromas.Melanocytes represented by melanocytic nevi (junctional, intradermic and compound) were the most frequent benign neoplasms, followed by epidermoid cysts. Our results illustrate the most common benign tumors observed in a dermatology department.

Lobular capillary hemangioma (pyogenic granuloma) has been reported more frequently in the skin (88%) than in the mucous membranes (12%). Granuloma gravidarum is a pyogenic granuloma that develops during pregnancy, often in the oral mucosa. Estrogens apparently increase the inflammatory response of mucous membranes. In this article, we describe the first case of a granuloma gravidarum of the scalp.

Necrotising fasciitis is a severe, life-threatening soft tissue infection. It produces an extensive cellulitis with severe involvement of subcutaneous tissue, fascia, muscle or both, resulting in necrosis of the tissue. All age groups, including neonates, can be affected. Patients with necrotising fasciitis present with more severe constitutional symptoms and have a poor outcome, unless aggressive antibiotic therapy and surgical debridement are instituted promptly. The debridement of necrotic tissue is imperative to control the infection, but results in deep wounds that require further treatment. In this study, the neonate was treated with alginate dressings and negative pressure therapy after resolution of cellulitis, with excellent results and no untoward events.