Metástasis cutánea de adenocarcinoma de ovario

—A 67-year-old woman without relevant past history and in good health developed numerous infiltrated erythematous plaques with a reticular pattern and a bruised appearance over her abdominal wall. Some of these plaques had 2 to 3 mm serohemorrhagic vesicles on their surface. Histopathologic study revealed metastatic papillary cystadenocarcinoma of ovarian origen.     

Metástasis cutáneas de origen visceral

Cutaneous metastases are relatively rare in clinical practice and their diagnosis requires a high index of suspicion because clinical findings can be subtle. These metastases reveal the presence of disseminated malignant disease and can lead to the diagnosis of unsuspected internal tumors or the spread or recurrence of an already diagnosed tumor. Early recognition of cutaneous metastases can facilitate prompt and accurate diagnosis resulting in early treatment; however, they are generally indicative of a poor prognosis. Some tumors have a predilection to metastasize to specific areas. Recognition of these patterns provides essential information that can guide the search for the underlying tumor.     

Metástasis cutáneas de cáncer de mama: 8 años de revisión en un centro de tercera complejidad

Background and objectivesBreast cancer is the most common cause of cutaneous metastases. In our review of the literature, we found no studies that have investigated the prevalence of cutaneous metastases from breast cancer in Latin America or compared survival in relation to the site of cutaneous involvement or the presence of visceral metastases.The aims of this study were to characterize the prevalence and clinical features of cutaneous metastases from breast cancer and analyze survival in relation to site of involvement and the concomitant presence of visceral metastases.Materials and methodsRetrospective cohort study. We evaluated patients with breast cancer and histologically confirmed cutaneous metastases.ResultsData from 914 patients with breast cancer seen between 2007 and 2014 were analyzed. Thirty-one of the patients, all women, had cutaneous metastases (prevalence, 3.4%; 95% CI, 2.3%-4.7%). The most common form of metástasis was nodular, metachronous, and asymptomatic.There were discrepancies between the immunohistochemical findings for the primary tumor and the metastases in 5 of 21 women. The metastases were locorregional in 23 patients and distant in 8. No differences were observed between patients with locorregional and distant metastases for survival after diagnosis of the primary tumor (median of 4.7 vs. 4.8 years; P=.085) or the cutaneous metastases (median of 2.9 vs. 1.1 years, P=.06). Women with a simultaneous diagnosis of cutaneous and visceral metastases had the shortest survival.ConclusionsThis is the first study in Latin America to estimate the prevalence of cutaneous metastases from breast cancer and we found it to be lower than rates reported for other parts of the world.     

Lesiones cutáneas asociadas a nevos sebáceos de Jadassohn. Estudio de 366 casos

—Introduction. Nevus sebaceous of Jadassohn (NS) is a hamartoma that affects the epidermis, ectopic eccrine and apocrine glands and hair follicles. It has typically been described as associated with multiple types of cutaneous neoplasms.Material and methods. We retrospectively analyzed all cases of nevus sebaceous from the files of the Pathology Department of the Hospital 12 de Octubre, from 1986 to 2001.Results. Of the 366 cases studied, 207 were males and 150 females. The average age at the time of diagnosis was 38 years (2-85). 28 were excised in children under 16. In our series, the four lesions most frequently associated with NS were viral warts (4.09%), syringocystadenoma papilliferum (3.27 %), trichoblastoma (2.18 %) and basal cell carcinoma (1.91 %). Viral warts were the most frequent finding in children under 10 with NS (average age: 18.8; range 4-44). No associated malignant neoplasms were found in patients under the age of 27.Conclusion. As a conclusion, our experience supports the idea that most of the lesions associated with NS in children under the age of 10 are viral warts. The presence of a viral wart in NS does not exclude malignancy, even though this complication is infrequent in patients under 30. Dermatologists and pathologists should bear these facts in mind in order to improve the care of these patients.     

Vehiculización de fármacos asistida por láser

Absorption of topical products through the epidermis is limited by the skin's barrier function. Numerous techniques and agents such as microneedling, dermabrasion, radiofrequency, and lasers have been used to increase penetration within an approach known as transdermal drug delivery. One of these techniques is laser-assisted drug delivery (LADD), which often uses ablative fractional lasers (CO₂ or erbium:YAG lasers) because of their capacity to produce microscopic ablated channels. The parameters in LADD need to be adjusted to the patient, the skin condition and its location, and the drug. LADD has been used with various topical products, such as corticosteroids, photosensitizers, and immunotherapy agents (imiquimod or 5-fluorouracil) to treat numerous conditions, including scars, nonmelanoma skin cancer, and photodamage. LADD is a promising technique that enhances the absorption of topical molecules while adding the synergic effect of the laser.     

Experiencia en el tratamiento de satelitosis y metástasis cutáneas en tránsito de melanoma con interleucina 2 intralesional

IntroductionAlthough metastatic melanoma has a poor prognosis, cutaneous metastases represent a special case given their ready accessibility, making it possible for dermatologists to apply local treatment. We report our experience with intralesional treatment with interleukin (IL) 2 in 7 patients with cutaneous metastases from malignant melanoma.Material and methodsA total of 244 lesions in 7 patients with satellitosis and/or cutaneous metastases from malignant melanoma were treated with intralesional IL-2 twice a week. The maximum dose in each patient ranged from 3 to 18 million units per session, according to the number and size of lesions.ResultsComplete or partial remission was achieved in almost all lesions (95.9 % and 3.7 %, respectively). Only 1 lesion (0.4 %)—the largest and located subcutaneously—did not respond to intralesional treatment and required alcoholization and subsequent surgical removal to achieve cure. All partial responses occurred in subcutaneous lesions larger than 2 cm. Treatment was well tolerated with only a few mild side effects (grade 1-2).ConclusionsIL-2 may be an effective and well-tolerated treatment option in patients with satellitosis and cutaneous metastases from melanoma. Lesions smaller than 2 cm and located in the epidermis or superficial dermis respond better than those larger than 2 cm or located in the subcutaneous cellular tissue. More studies are necessary to establish appropriate doses and regimens.     

Colgajos de avance con triángulo de Burow en la cara

—Dermatologic surgery of the face demands for an ample precise knowledge of superfcial anatomy. Numerous anatomic structures, very important from a cosmetic point of view, need to be preserved.The Burow's triangle advancement flap provides an excellent method for repair of wound defects of variable sizes with good cosmetic results. The main indications of this flap are wounds located on the upper lip, the lateral eyebrow and the preauricular area. The Burow's triangle allows the surgeon to advance the flap with minimal tension, avoiding dog-ears formation.     

Carcinoma epidermoide cutáneo de alto riesgo

Cutaneous squamous cell carcinoma (cSCC) is the second most common form of skin cancer and its incidence has increased in recent decades. Most cSCCs are successfully treated by surgery, but local and distant metastases develop in approximately 5% of cases; this proportion is higher in certain forms of cSCC with high-risk factors, namely: tumor size >2 cm, depth >2 mm, Clark level ≥IV, perineural invasion, lymphovascular invasion, poor differentiation, certain histologic subtypes (desmoplastic or adenosquamous carcinoma, invasive Bowen disease, or a cSCC arising in areas of chronic inflammation), immunosuppression, human papillomavirus infection, high-risk anatomic location (pinna of the ear, labial mucosa), expression of certain tumor genes, and inadequate tumor resection. The latest TNM (tumor, lymph node, metastasis) classification of cSCC published by the American Joint Committee on Cancer (AJCC) in the seventh edition of its Cancer Staging Manual now incorporates several of these risk factors to improve disease staging. We review all the factors currently considered to be markers of poor prognosis in cSCC and analyze the new AJCC classification and the different treatment options for high-risk cSCC.     

Placas colágenas degenerativas de las manos

—Degenerative collagenous plaques of the hands are a rare acquired disorder, normally included among marginal papular acrokeratodermas. We present a case of degenerative collagenous plaques of the hands in a 44-year-old woman, whose triggering factors are clearly mechanical in nature. The clinical, histological and ultrastructural findings are set out, and its current nosologic status is discussed on the basis of these findings.     

Enfermedad de Bowen,análisis de 64 casos en Colombia

Introduction

Bowen's disease is a squamous cell carcinoma in situ. Its prevalence is higher in women, and mainly occurs in sun-exposed skin. It typically presents as well-demarcated scaly plaques. Multiple treatments currently exist, with the most common being surgical excision. Using several cases, this study describes the clinical and demographic characteristics of this disease in Bucaramanga, Colombia, with this being the first data reported on this condition in Latin-America.