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Background: Fragrances constitute the second most frequent cause of allergic contact dermatitis in Spain. Objectives: To determine the rate of sensitization to the individual fragrances of fragrance mix (FM) I and FM II for each of the demographic and clinical factors included in the MOAHLFA (male, occupational dermatitis, atopic dermatitis, hand dermatitis, leg dermatitis, facial dermatitis, age) index. Methods: We conducted a 5-year retrospective study in 23 Spanish centres. We identified the patients who had undergone patch testing with a specific fragrance series after reacting positively to fragrance markers in a baseline series. We obtained the MOAHLFA index items in this population, then calculated for each demographic and clinical factor the frequencies of sensitization to the individual fragrances of FM I and FM II. Results: A specific fragrance series was patch tested in 1013 patients. The most frequent allergens in men, women, children, and retired people were Evernia prunastri (16%), geraniol (16.6%), isoeugenol (17.9%), and geraniol (22.4%), respectively. Citral (20.5%) and hydroxyisohexyl 3-cyclohexene carboxaldehyde (HICC) (14.5%) were the most common allergens in occupational eczemas and were also associated with a large proportion of hand and facial dermatitis. Conclusions: Frequency of sensitization to the individual fragrances of FM I and FM II varies with age, sex, affected body region, and history of occupational or atopic dermatitis.

Resumen Con el progresivo control de la pandemia por SARS-CoV-2, los miembros del Grupo Espanol de Investigacion en Dermatitis de Contacto y Alergia Cutanea (GEIDAC) realizan una propuesta sobre cuales van a ser los requisitos, las limitaciones y los condicionantes para reanudar el servicio en las unidades de dermatitis de contacto en un escenario en el que se presume la persistencia del virus, con episodios ocasionales o estacionales de exacerbacion. Se aconseja ajustar el numero de pruebas epicutaneas (PE) a las posibilidades de cada centro y la revision de los casos en lista de espera para priorizar a los pacientes en funcion de la gravedad y la urgencia. Se ofreceran, si es factible, metodos telematicos para los documentos relativos a las PE (informacion, pautas, documentos de consentimiento informado). De estar disponible, puede ofrecerse la opcion de realizar una primera visita telematica. Igualmente, en pacientes seleccionados puede llevarse a cabo una televisita en las visitas de lectura a traves de imagenes realizadas por el paciente o mediante una videovisita que permita visualizar el resultado de la exploracion. Estas acciones permitiran reducir el numero de visitas presenciales, aunque no el tiempo dedicado y asignado al facultativo para los actos medicos. Todas estas recomendaciones son sugerencias y se adaptaran a los requisitos y a las posibilidades de cada centro sanitario

Patients with rhupus characteristically exhibit symmetric polyarthritis and clinical manifestations suggestive of systemic lupus erythematosus (malar rash, photosensitivity, hematological manifestations, serositis, and/or skin involvement) and positive anti-dsDNA. Treatment is unclear and it can include disease-modifying rheumatic drugs like hydroxyl chloroquine, or methotrexate or, in refractory cases, rituximab or abatacept. We report a case of 31-year-old female who present with rhupus with skin acute lesions treated with belimumab. This is the first case of rhupus treated with this drug described in the literature.

Background: Fragrance chemicals constitute the second most frequent cause of con in Spain. There are no data available concerning the individual fragrances that are frequently involved. Objectives: To describe the diagnostic contribution provided by specific fragrance series to the results obtained with baseline series fragrance markers by correlating the results of both series. Materials and methods: We performed a 5-year retrospective study of fragrance marker positive patients tested with specific fragrance series in 23 Spanish centres. We collected the demographic and clinical characteristics, and compared the results of patch tests obtained from different suppliers. Results: Of 19 588 patients patch tested with the Spanish baseline series, 1590 (8.1%) reacted positively to a fragrance marker. Of these, 1013 (63.7%) were patch tested with a fragrance series, and 664 patients reacted positively to at least one individual fragrance other than hydroxyisohexyl 3-cyclohexene carboxaldehyde. Geraniol was the most frequent allergen. Positive reactions to substances not included in fragrance mix (FM) I or FM II were found in 230 patients. Of the 436 FM I-positive patients and the 419 FM II-positive patients, 184 (42%) and 64 (39.1%), respectively, had no positive reactions to fragrance series. In the case of FM I, negative results were more common when individual fragrances were patch tested at low concentrations. Conclusions: We recommend patch testing all patients positive for any fragrance marker with a specific fragrance series. The correlation between the results of baseline series and fragrance series could be improved by increasing the concentrations of individual fragrances

Resumen Introduccion y objetivo La tecnica de la biopsia selectiva del ganglio centinela (BSGC) es la mejor herramienta para la estadificacion ganglionar en el melanoma, permitiendo la realizacion de una linfadenectomia selectiva, es decir, reservada solo a aquellos pacientes que muestran el GC positivo para metastasis. Nuestro objetivo fue evaluar el coste economico de la tecnica de la BSGC, ya que se ha convertido en el procedimiento recomendado como estandar en la atencion al paciente con melanoma, y es necesaria para la inclusion de los pacientes en los ensayos clinicos. Existe ademas escasa bibliografia en nuestro medio sobre su relevancia economica. Metodo De forma prospectiva se recogieron 100 pacientes a los que se realizo la tecnica entre los anos 2007-2010 con un procesamiento histologico transhiliar bivalvo multisecciones. Realizamos un calculo aproximado del precio de la tecnica utilizando las tarifas de precios oficiales de la Region de Murcia. Resultados El porcentaje de positividad de nuestra serie fue del 20%, con un numero medio de ganglios de 1,96 y un 44% de melanomas delgados. El precio total de la tecnica es de 9.486,57-10.471,29 euros, siendo una parte muy importante de la misma atribuible al procesamiento histopatologico (5.769,36 euros). Discusion La tecnica de la BSGC tiene un precio muy considerable, aunque en consonancia con otras referencias americanas previamente descritas. La optimizacion de la tecnica vendra dada en funcion de la seleccion cada vez mas adecuada de los pacientes que deben someterse a ella, y a la estandarizacion de un modelo histopatologico sensible en la deteccion, pero a la vez sencillo en el procesamiento.

Introduction and objective Sentinel lymph node biopsy (SLNB) is the most useful tool for node staging in melanoma. SLNB facilitates selective dissection of lymph nodes, that is, the performance of lymphadenectomy only in patients with sentinel nodes positive for metastasis. Our aim was to assess the cost of SLNB, given that this procedure has become the standard of care for patients with melanoma and must be performed whenever patients are to be enrolled in clinical trials. Furthermore, the literature on the economic impact of SLNB in Spain is scarce. Method From 2007 to 2010, we prospectively collected data for 100 patients undergoing SLNB followed by transhilar bivalving and multiple-level sectioning of the node for histology. Our estimation of the cost of the technique was based on official pricing and fee schedules for the Spanish region of Murcia. Results The rate of node-positive cases in our series was 20%, and the mean number of nodes biopsied was 1.96; 44% of the patients in the series had thin melanomas. The total cost was estimated at between €9486.57 and €10 471.29. Histopathology accounted for a considerable portion of the cost (€5769.36). Discussion The cost of SLNB is high, consistent with amounts described for a US setting. Optimal use of SLNB will come with the increasingly appropriate selection of patients who should undergo the procedure and the standardization of a protocol for histopathologic evaluation that is both sensitive and easy to perform.

Resumen Antecedentes La exposicion cronica a las radiaciones solares provoca el envejecimiento patologico de la piel (fotoenvejecimiento) y es uno de los principales factores etiologicos implicados en el desarrollo del cancer cutaneo. Metodos Para el presente experimento, hemos expuesto 20 ratones SKH-1 a radiaciones ultravioleta, que se aplicaban tres veces a la semana durante 60 min (80 sesiones). Las zonas expuestas a las radiaciones han sido estudiadas macro y microscopicamente. Resultados El 100% de los animales tratados desarrollaron neoplasias malignas, asi como los signos tipicos del fotoenvejecimiento. Conclusiones Debido a la gran similitud de las lesiones desarrolladas por los animales, con las que tienen lugar en la piel humana tras la exposicion cronica a las radiaciones ultravioleta, consideramos este modelo, idoneo para el estudio del fotoenvejecimiento y la fotocarcinogenesis, asi como para el ensayo de sustancias antioxidantes y fotoprotectoras.

Background and Objective: Radiofrequency represents the most recent skin-rejuvenation treatment. The aim of this study was to study the changes in tissues and cells, as well as in the thickness and structure of the skin of guinea pigs following several sessions of radiofrequency. Materials and Methods: Six sessions (1 session/week) of radiofrequency (Thermafine Lift device, Grupo Solilaser, S.L., Girona, Spain) were applied to the skin of guinea pigs. Biopsies were taken following each session and 2 months following the last application. The resultant samples were included in paraffin via the usual method, sectioned at 5mm and stained with Haematoxylin-Eosin, Alcian blue, Tolui- dine blue, van Gieson's and Verhoeff's stains. These techniques were used in order to observe possible changes in the thickness and structures of the skin: mucopolysac- charides and collagen and elastic fibres. Results: The most relevant changes were found in the papillary dermis which underwent an expansion due to oedema and vascular congestion (first half of the experi- ment), followed by an increase in cellularity and the accumulation of intercellular substance. An increase in collagen, elastic fibres and mucopolysaccharides was observed. Conclusion: The Thermafine Lift device caused no significant macroscopic or microscopic alterations in the skin of guinea pigs, yet increased both the thickness, as well as the mucopolysaccharide, collagen and elastic-fibre content. Lasers Surg. Med. 40:76-82, 2008. 2008 Wiley-Liss, Inc.

Available data have led to a controversy on the relationship between human leukocyte antigen (HLA) and cutaneous malignant melanoma susceptibility or prognosis. Moreover, the influence of HLA-C on melanoma has not yet been well established. Therefore, the aim of the current study was to analyze the possible influence of the HLA system on melanoma susceptibility and prognosis in the Spanish population. For this purpose, HLA-A and HLA-B serotyping and HLA-C, HLA-DRB1, and HLA-DQB1 genotyping by polymerase chain reactions using sequence-specific oligonucleotide (PCR-SSO) and sequence-specific primer (PCR-SSP) were performed in 174 melanoma patients and 227 ethnically matched controls. The number of controls was increased up to 356 for HLA-C typing. Patients were stratified according to the histological subtypes of melanoma, sentinel lymph node status, tumor thickness, and ulceration of primary lesion. No HLA-A, HLA-B, HLA-DRB1, or HLA-DQB1 relationship with melanoma was observed for susceptibility or disease prognosis. However, the analysis of HLA-C locus showed that individuals homozygous for HLA-C(Lys80) were significantly more frequent within the patient than the control group. Remarkably, individuals homozygous for group 2 HLA-C alleles (HLA-C(Lys80)) seem to be associated with metastatic progression of melanoma. In contrast, we found a negative association between group 1 HLA-C alleles (HLA-C(Asn80)) and disease susceptibility or metastasis development. In conclusion, although an association with HLA-A, HLA-B, HLA-DRB1, or HLA-DQB1 was not demonstrated, the study of the HLA-C locus revealed that the analysis of the dimorphism at position 80 in the alpha1 helix may help to evaluate the risk and prognosis of melanoma in our population.

Resumen Introduccion La localizacion anatomica del melanoma cutaneo se ha considerado como un factor pronostico independiente. En este trabajo se trata de comprobar si la localizacion del tumor primario influye en la deteccion del ganglio centinela en el melanoma cutaneo. Pacientes y metodo Se ha estudiado a 212 pacientes con melanoma cutaneo primario (96 en los miembros, 89 en el tronco y 27 en la cabeza o el cuello) en los que se realizo la biopsia del ganglio centinela. Se estudio la adecuada localizacion gammagrafica y quirurgica y se compararon las variables epidemiologicas e histopatologicas, el numero de drenajes por lesion y de ganglios centinela por drenaje y la positividad del estudio de los ganglios. Para los drenajes procedentes de los tumores de la cabeza y el cuello se estudio el drenaje hacia territorio de la glandula salival como variable relacionada con la localizacion del ganglio centinela. Resultados La localizacion fue peor para los tumors de cabeza y cuello (88,8%), tanto gammagrafica (p Conclusiones Los melanomas cutaneos localizados en la cabeza y el cuello presentaron mas fallos en la identificacion del ganglio centinela. La localizacion del ganglio centinela adyacente a una glandula salival es un factor que influye en su adecuada deteccion. Los melanomas cutaneos del tronco presentan un mayor numero de drenajes por lesion que los localizados en las extremidades o en la cabeza y el cuello.

Resumen Introduccion La produccion de citocinas tiene un papel primordial en la lucha antitumoral por parte del sistema inmunitario. Por ello, en este trabajo nos propusimos investigar si las concentraciones sericas de distintos tipos de citocinas en pacientes con melanoma se asociaban con la evolucion de su enfermedad. Material y metodos Se analiza la variacion en los niveles sericos de citocinas representativas de los fenotipos Th1 (interferon gamma [IFN-γ] e interleucina 15 [IL-15]) y Th2 (IL-6 e IL-10) en 33 pacientes con melanoma cutaneo primario. Se obtuvieron semestralmente muestras de sangre periferica hasta conseguir un total de cuatro muestras por paciente. Resultados A los 30 meses, 29 pacientes (87,9 %) sobrevivieron sin signos de recidiva. La IL-10 basal era mas alta en el grupo de enfermos que fallecieron que en los supervivientes. En los pacientes que fallecieron se observo un aumento de la IL-6 serica en la ultima muestra. No se pudo demostrar ninguna relacion entre los niveles de IFN-γ e IL-15 y la progression del melanoma. Conclusion La determinacion de citocinas de tipo Th2 (IL-6 e IL-10) en suero de pacientes con melanoma podria ser util en el seguimiento clinico de estos enfermos y servir como factor predictivo de la mejor o peor evolucion de la enfermedad, en el sentido de un peor pronostico para los enfermos con niveles elevados de IL-10 e IL-6. Por el contrario, la determinacion de los niveles sericos de las citocinas de tipo Th1 (IL- 15 e IFN-γ) no parece de tanta utilidad a la hora de orientar sobre el pronostico.

Resumen Introduccion El estudio mediante pruebas de contacto estandar es fundamental para diagnosticar y tratar cualquier paciente en el que se sospeche una dermatitis de contacto. El primer estudio estadistico con pruebas epicutaneas estandar del Grupo Espanol de Investigacion de Dermatitis de Contacto (GEIDC) data de 1977. Veinticinco anos mas tarde, se realiza este estudio que tiene como objetivo valorar la prevalencia y la relevancia de las positividades a los alergenos de la serie estandar del GEIDC. Metodos Todos los pacientes fueron estudiados mediante la serie estandar del GEIDC (29 alergenos) en 13 centros dermatologicos. Se valoraron los siguientes parametros: sexo, edad, localizacion, diagnostico, causa del eccema, positividades y relevancia total, presente y pasada. Resultados El 55,11 % de los 3.832 pacientes estudiados (2.300 mujeres y 1.532 varones) tuvieron alguna positividad en la serie estandar. Los diagnosticos mas frecuentes fueron la dermatitis de contacto alergica en el 31,02 % e irritativa en el 15,88 %. El origen mas comun de la dermatitis fue profesional en el 16,66 % de los casos, y la metalurgia y la construccion fueron las ocupaciones mas prevalentes. Mas de la mitad de los pacientes sufrian eccema en manos (54,34%). El alergeno mas prevalente fue el niquel (26,64%) seguido de cobalto (9,89 %) y cromo (8,66 %). Conclusiones Comparando los datos de este estudio con el realizado por el GEIDC en 1977 comprobamos como ha aumentado la alergia a niquel mientras ha disminuido la debida a cromo y cobalto. Alergenos no incluidos anos atras como tiomersal, mezcla de perfumes y Kathon CG muestran actualmente una alta prevalencia. Es siempre fundamental establecer la relevancia de las pruebas positivas, que es alta en este estudio para las gomas y para el niquel.

La alopecia androgenetica es un motivo de consulta cada vez mas frecuente. La valoracion clinica de este proceso es dificil y en la mayoria de las ocasiones se hace de forma exclusivamente subjetiva. Aunque se han publicado diversos sistemas, empleados generalmente en ensayos clinicos, se trata de metodos complicados que no estan al alcance de todos los dermatologos. Por ello, nos ha parecido interesante valorar la utilidad de un metodo simple, la fotografia, en el control de los pacientes con alopecia androgenetica en tratamiento con un farmaco de probada eficacia, la finasterida, a dosis de 1 mg/dia.

Fundamentos Se refiere la experiencia para la deteccion del ganglio centinela en el melanoma utilizando unicamente la linfogammagrafia preoperatoria y trazador radiactivo con sonda de deteccion de radiacion gamma intraoperatoria. Pacientes y metodo Se estudio a 60 pacientes con melanoma en estadios I-II, a quienes se realizo biopsia selectiva del ganglio centinela mediante su localizacion con sulfuro coloidal marcado con Tc-99m. A todos se les efectuo una gammagrafia preoperatoria y se trato de localizar el ganglio centinela con una sonda de deteccion de radiacion gamma. Se han estudiado los resultados de la gammagrafia preoperatoria, la eficacia tecnica en la localizacion intraoperatoria, asi como los resultados anatomopatologicos y del seguimiento de los pacientes. Resultados La tasa de deteccion preoperatoria fue del 98,3%, con una media de 1,17 drenajes por lesion, siendo multiples especialmente en los melanomas de tronco. La localizacion intraoperatoria (eficacia tecnica) fue del 98,48%, con dificultades para su localizacion en la region parotidea. En el estudio histopatologico fueron fundamentales las tecnicas de inmunohistoquimica con HMB45, resultando positivos un 10%, por lo que se evito la linfadenectomia en el 90% de los casos. No se observaron recidivas y las metastasis se dieron en casos inabordables. La morbilidad de la tecnica fue significativamente menor que la de la linfadenectomia. Conclusiones La linfogammagrafia preoperatoria y el uso de sonda de deteccion de radiacion gamma, como tecnica de localizacion del ganglio centinela en el melanoma, tienen una elevada eficacia tecnica, permiten detectar drenajes multiples y posibilitan un abordaje muy selectivo y con diseccion minima.

We have studied whole blood glutathione peroxidase activity as a possible diagnostic factor or marker for detection and diagnosis of patients with melanoma. This activity was determined in 40 melanoma patients (MP) and in 40 healthy persons (HP) using an enzymatic method. We found a mean value of 17.90±6.82 units/ml in MP and 27.07±14.35 units/ml in HP. A very significant decrease in whole blood glutathione peroxidase activity was observed in MP in comparison to the enzymatic activity in HP ( P =0.0005). In order to check whether this test could discriminate between MP and HP, a complete statistical Receiver Operating Characteristic (ROC) curve analysis was performed. The cut-off value was 14.26 units/ml. The area under the curve was 0.737. According to these results, the test could discriminate adequately between both groups. However, the high specificity and low sensitivity values associated with that cut-off value would make this test a very valuable tool for confirming the detection, rather than for primary screening.

We have studied the serum tyrosine hydroxylase activity of tyrosinase, the key enzyme in the melanogenesis via, as a possible diagnostic factor or marker for detection, prognosis and follow-up of patients with melanoma. This activity was determined in 30 melanoma patients (MP) and in 30 healthy persons (HP) by using a radiometric method. We found mean values of 10.8+/-3.0 and 7.65+/-2.32 mU/l for serum tyrosine hydroxylase activity in MP and HP, respectively. A very significant increase in serum tyrosine hydroxylase activity was observed in MP in comparison to the enzymatic activity in HP (P0.00001). Although these data seem very conclusive, we wanted to know whether this test could discriminate adequately between MP and HP. In order to reach this aim, a complete statistical study was performed by using receiver operating characteristic (ROC) curve analysis. The cut-off value obtained was 8.47 mU/l. According to our results and after analytical treatment of the data, we can confirm that evaluation of tyrosine hydroxylase activity in serum could be a quick and reliable diagnostic method for detection, prognosis and follow-up in melanoma patients.

Resumen El penfigoide ampolloso es una enfermedad que caracteristicamente afecta a personas de edad avanzada aunque se han descrito casos en ninos. Presentamos un caso de penfigoide ampolloso en una lactante de 2 meses de vida con lesiones ampollosas en palmas y plantas, que aparecieron una semana despues de recibir la primera dosis de la vacuna contra la hepatitis B, poliomielitis, difteria-tetanos-pertussis (DTP) y Haemophilus. Recibio tratamiento con agua sulfatada, dexametasona y acido fusidico, con lo que desaparecieron las lesiones. Un mes despues presento un nuevo brote, mas generalizado, a los 3 dias de la segunda dosis de la misma vacuna. La erupcion cutanea cedio por completo a los 3 meses de instaurar tratamiento con deflazacort (1 mg/kg/dia). Tras 5 anos de seguimiento, no ha vuelto a presentar lesiones a pesar de haber recibido el resto de vacunas del calendario oficial.

Background. Hand eczema is common in children, but affected children are seldom patch tested. Relatively few studies have assessed patch testing in the paediatric population, and none has specifically evaluated its use in hand eczema in children. Objectives. The aim of this study was to determine the prevalence of contact allergy in children with hand eczema, and to identify the most frequent allergens and their relevance. Material and methods. We performed a 5-year retrospective study of children (aged 0–15 years) with hand eczema tested with the Spanish baseline series at the Dermatology Departments of 11 Spanish hospitals. Results. During the study period, 11 729 patients were patch tested, of whom 480 were children. Hand eczema was present in 111 (23.1%) of the children and in 3437 (30.5%) of the adults. Of the children with hand eczema, 46.8% had at least one positive reaction in the patch tests. Current relevance was found for 78% of the allergens detected. The most common allergens were nickel sulfate, methylchloroisothiazolinone/methylisothiazolinone, and fragrance mix I. Allergic contact dermatitis was the most frequent diagnosis (36%), followed by atopic dermatitis. Conclusions. Allergic contact dermatitis was the most usual diagnosis in our series of children with hand eczema. We recommend patch testing of all children with chronic hand eczema, as is already performed in adults.

The production of cytokines plays a primordial role in the immune systems fight against tumors. Therefore, we proposed to investigate whether the serum levels of different types of cytokines in melanoma patients were associated with the evolution of their disease.We analyzed the variation in the serum levels of cytokines representative of the Th1 (INFg and IL-15) and Th2 (IL-6 and IL-10) phenotypes in 33 patients with primary cutaneous melanoma. Peripheral blood samples were obtained every six months until we had a total of 4 samples per patient.After 30 months, 29 patients (87.9 %) had survived with no signs of recurrence. Basal IL-10 serum levels were higher in the group of patients who expired than in the survivors. Among the patients who expired, an increase in IL-6 serum levels was observed in the last sample. No relationship could be proven between INFg and IL-15 levels and melanoma progression.Determining the levels of type Th2 cytokines (IL-6 and IL-10) in the serum of melanoma patients could be useful in the clinical follow-up of these patients and serve as a predictive factor for the progression of the disease, with the prognosis being worse for patients with high IL-10 and IL-6 levels. On the other hand, determining the serum levels of type Th1 cytokines (IL-15 and INFg) does not seem to be as useful in predicting the prognosis.

Bullous pemphigoid (BP) is a disease that characteristically affects the elderly, although cases have been described in children. We present a case of BP in a two-month-old infant with bullous lesions on the palms and soles, which appeared one week after receiving the first dose of the hepatitis B, polio, DTP and HiB vaccine. She was treated with sulphated water, dexamethasone and fusidic acid, and the lesions disappeared. One month later, she presented with a new, more generalized outbreak, three days after the second dose of the same vaccine. The skin eruption completely subsided 3 months after treatment with deflazacort was initiated (1 mg/kg/day). After five years of follow up, the patient has not presented with lesions again, despite having received the rest of the vaccines on the official schedule.

The anatomical location of cutaneous melanoma has been suggested to be an independent prognostic factor. The aim of the present study was to determine whether the location of the primary tumor influences sentinel node detection in cutaneous melanoma.Two hundred twelve patients with primary cutaneous melanoma (96 of the limbs, 89 of the trunk and 27 of the head or neck) who underwent sentinel lymph node biopsy were studied. Adequate lymphoscintigraphic and surgical localization was evaluated and epidemiological and histopathological variables, the number of lymph nodes draining the site of the primary lesion, sentinel nodes per drainage basin, and tumor-positive nodes were compared.Localization was less successful for tumors of the head and neck (88.8%), both with lymphoscintigraphy (P.001) and surgery (P.0005), especially for lymph nodes adjacent to salivary glands (P.0005). Melanomas of the trunk showed a greater number of nodes per lesion and wider variability in drainage pathways (P.0005), although there were no differences in the number of sentinel nodes per drainage basin (P=.455).Sentinel node detection with less successful in cutaneous melanomas located in the head and neck. Location of the sentinel node adjacent to a salivary gland is a factor that influences its detection. Cutaneous melanomas of the trunk showed a higher number of draining nodes per lesion than those located in the limbs or head and neck.

To the Editor: Dapsone has long been used to treat leprosy. Nowadays, it is also used in the treatment of a variety diseases. Many side effects have been described, the most frequent at pediatric age being methemoglobinemia [1, 2]; other side effects include Dapsone hypersensitivity syndrome (DHS) [1]. To date, only three cases of isolated acute pancreatitis have been described with the use of Dapsone [1, 3]. A boy, aged 3 y and 5 mo presented with vomiting and abdominal pain for 48 h. Linear IgA dermatitis had been diagnosed at two and a half years of age, and had been well controlled with Dapsone (18 mg/d). He had two previous admissions with similar symptoms improving after Dapsone withdrawal. Physical examination showed diffuse abdominal pain, with no signs of peritoneal irritation. A complete blood cell count and coagulation profile were normal. Serum chemistries showed: C-reactive protein 32.9 mg/dL; pancreatic amylase 236 IU/L [normal: 60–80 UI/L]; lipase 318 IU/L [normal: 23–250 UI/L]; total calcium, hepatic profile, electrolytes, glucose, lipid profile, urea and serum creatinine within normal limits. Infections and celiac disease were dismissed. Abdominal ultrasound revealed diffuse enlargement of the pancreas, with homogeneous echogenicity and absence of focal lesions. Computed tomography (CT) suggested mild acute pancreatitis (CT Severity Index:1) (Fig. 1). Dapsone was interrupted, along with NPO and fluid and electrolyte replacement. Gastrointestinal symptoms disappeared within 24 h. Five days after admission the biochemical parameters became normal (amylase 36 IU/L; lipase 73 IU/L). Although the outcome is generally good, internal organ complications, and deaths can occur with Dapsone treatment [4]. Frequently, adverse effects become evident 2–7 wk after the beginning of treatment [1–3, 5]. In our patient, the occurrence of repeated episodes of abdominal pain and vomiting and their improvement after interruption of Dapsone, the increased levels of pancreatic enzymes and the comprehensive exclusion of other possible causes of pancreatitis led us to suspect isolated acute pancreatitis induced by Dapsone. This was confirmed by the clinical and biochemical improvement observed after discontinuation. For ethical reasons, the patient was not re-exposed to the drug (Naranjo Scale Score: 8). To our knowledge this is the first report of isolated acute pancreatitis probably induced by Dapsone at pediatric age. This entity should be borne in mind, considering the increased use of this drug in recent years. A. Navarro-Mingorance :A. J. Castellanos-Alcarria : S. Ibanez-Mico :A. Cervantes-Pardo Department of Pediatrics, Universitary Hospital Virgen Arrixaca, Murcia, Spain

Background. An important factor to be considered when performing lymphogammagraphy in melanoma patients is the adequate distance of injection of the radiopharmaceutical from the biopsy excision site or the primary lesion. Objective. To test the reproducibility of lymphatic mapping in patients with primary cutaneous melanoma who had undergone narrow excisional biopsy by injecting a technetium marker at different distances from the biopsy scar. Methods. After informed consent, two lymphoscintigraphies were performed on each of 19 melanoma patients, following narrow excisional biopsy. Four aliquots of the radiocolloid were intradermally injected in each procedure, surrounding the biopsy excision site at 1.5 and 0.5 cm, respectively. Results. Both lymphoscintigraphies showed similar lymph channels and sentinel node(s). Conclusion. In melanoma patients who have undergone narrow excisional biopsy, lymphoscintigraphy marks with accuracy the sentinel node, at least when the radiopharmaceutical is injected at a distance of less than 1.5 cm from the limits of the biopsy scar.