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Resumen Objetivos Presentar nuestra experiencia en el diagnostico y tratamiento de los quistes de rafe medio atendidos en nuestro servicio en los ultimos 25 anos. Material y metodo Realizamos un estudio retrospectivo de 28 varones afectos de quistes de rafe medio intervenidos en nuestro servicio desde junio de 1990 a marzo de 2015. Se analizan la edad de presentacion, el motivo de consulta, las manifestaciones clinicas, los hallazgos en el estudio histologico, el tratamiento realizado y la evolucion tras su exeresis. Resultados La mayor parte de los pacientes (22; 79%) estaban asintomaticos y consultaron por el defecto estetico; 4 casos (14%) presentaron alteraciones miccionales y 2 (7%) refirieron molestias durante el acto sexual. En todos los casos el tratamiento consistio en la extirpacion quirurgica del quiste, obteniendo excelentes resultados esteticos y funcionales, sin recidiva de la lesion en ninguno de los pacientes durante un seguimiento medio de mas de 10 anos. El tipo histologico mas frecuentemente encontrado fue el de celulas transicionales en 15 casos (54%), seguido del tipo mixto (transicional y escamoso) en 11 casos (39%); en un caso (6%) fue de tipo escamoso puro y en otro caso (6%) el epitelio fue de tipo glandular. Conclusiones Los quistes de rafe medio constituyen un tipo infrecuente de disembrioplasia que pueden localizarse en cualquier punto del rafe medio, desde el meato balanico hasta los margenes del ano. Generalmente son asintomaticos y su tratamiento de eleccion es la extirpacion quirurgica.

Objectives To present our experience with the diagnosis and treatment of median raphe cysts treated in our department in the last 25 years. Material and method We conducted a retrospective study of 28 men with median raphe cysts who underwent surgery in our department from June 1990 to March 2015. We analyzed the age of presentation, reason for consultation, clinical manifestations, histological findings, treatment and outcome after exeresis. Results The majority of the patients (22; 79%) were asymptomatic and consulted for the esthetic defect. Four cases (14%) presented urinary abnormalities, and 2 cases (7%) reported discomfort during sexual intercourse. In all cases, the treatment consisted of surgical extirpation of the cysts, with excellent esthetic and functional results and no lesion recurrence in any of the patients during a mean follow-up of more than 10 years. The most common histological type was the transitional cell type in 15 cases (54%), followed by the mixed type (transitional and squamous) in 11 cases (39%). One case (6%) was pure squamous type, and in another case (6%) the epithelium was glandular. Conclusions Median raphe cysts are an uncommon type of disembryoplasia that can occur in any location of the median raphe, from the balanic meatus to the edges of the anus. These cysts are generally asymptomatic and their treatment of choice is surgical extirpation.

BackgroundPromoter methylation of tumour suppressor genes (TSGs) has recently been implicated in the pathogenesis of several types of cancer. Regarding melanoma, over 100 genes that contribute to its pathogenesis have been identified to be aberrantly hypermethylated. ObjectivesThis is a retrospective observational study that aims to analyse the prevalence of CpG island methylation in a series of primary melanomas, to identify the associations with the main clinicopathological features, and to explore the prognostic significance of methylation in melanoma survival. Materials and methodsDNA methylation was analysed using methylation-specific multiplex ligation-dependent probe amplification in a series of 170 melanoma formalin-fixed paraffin-embedded tumour samples. The relationship between the methylation status, known somatic mutations and clinicopathological features was evaluated. Disease-free survival (DFS) and overall survival (OS) were displayed by the Kaplan-Meier method. ResultsIn the entire cohort, one or more genes were detected to be methylated in 55% of the patients. The most prevalent methylated genes were RARB 31%, PTEN 24%, APC 16%, CDH13 16%, ESR1 14%, CDKN2A 6% and RASSF1 5%. An association between aberrant methylation and aggressive clinicopathological features was observed (older age, increased Breslow thickness, presence of mitosis and ulceration, fast-growing melanomas, advancing stage and TERT mutations). Furthermore, Kaplan-Meier survival analysis showed a correlation of methylation and poorer DFS and OS. ConclusionsAberrant methylation of TSGs is a frequent event in melanoma. It is associated with aggressive clinicopathological features and poorer survival. Epigenetic alterations may represent a significant prognostic marker with utility in routine practice. What's already known about this topic? Epigenetic aberrations have recently been implicated in the development and progression of many human cancers. Regarding melanoma, over 100 genes have been identified to be aberrantly hypermethylated. What does this study add? Aberrant methylation of tumour suppressor gene promoters is associated with aggressive clinicopathological features and poorer melanoma survival. What is the translational message? DNA methylation may represent a potential prognostic biomarker for the management of patients with melanoma in routine practice. Linked Comment:van Doorn. Br J Dermatol 2018; 179:250-251. Respond to this article

We report a patient with an acute infection with the human immunodeficiency virus (HIV), who initially presented due to a mononucleosis-like illness that included a rash on the upper trunk and limbs, and oral ulceration. The patient developed a haemophagocytic syndrome with severe systemic involvement. Three weeks after the initial presentation, lesions of a pancreatic panniculitis appeared on both legs.