Experiencia quirúrgica en el Centro Especializado en Tratamiento de Enfermedades de la Piel (CETEP) del Centro Hospitalario Pereira Rossell, desde 1996 hasta 2019

Los tumores cutáneos presentan una alta prevalencia en dermatología en el mundo, siendo los benignos más frecuentes que los malignos; sin embargo, estos últimos son más estudiados debido a su morbimortalidad. El objetivo principal de este estudio fue conocer los principales diagnósticos y técnicas quirúrgicas correspondientes desarrolladas en el Centro de Tratamiento de Enfermedades de la Piel (CETEP) entre 1996 y 2019, evaluando aspectos clínicos y demográficos. Se realizó un estudio retrospectivo y observacional que incluyó todo paciente con lesión cutánea y posterior resolución quirúrgica de la misma. En la muestra analizada (N 6.659) hubo un predominio del sexo femenino (68%) y la media de edad fue 53 ± 21 años. Los pacientes residían mayoritariamente en Montevideo (58%). Los tumores benignos fueron los más frecuentes (41%), seguidos de los malignos (28%), dentro de éstos: carcinoma basocelular (CBC) 66%, carcinoma espinocelular (CEC) 21% y melanoma (MM) 5%. Las técnicas quirúrgicas realizadas fueron cirugías convencionales (57%), principalmente losange (93%), seguidas de procedimientos de cirugía dermatológica (42%), predominando biopsias (52%) y afeitado con electrocoagulación (23%). Se destaca que el CETEP resolvió un número mayor de pacientes de centros externos que del propio Centro Hospitalario Pereira Rossell (CHPR): 59% no CHPR vs 41% CHPR. En conclusión, este trabajo proporcionó información nacional sobre la epidemiología de distintos tumores cutáneos, así como las técnicas quirúrgicas más utilizadas en su resolución. Además, estableció la importancia de la cirugía dermatológica y la capacidad del CETEP en dar respuesta a pacientes propios tanto como referenciados desde otros centros del sistema público.

Cutaneous tumors have a high prevalence in dermatology worldwide, with benign tumors being more common than malignant ones. Nevertheless, the latter are more extensively studied due to their associated morbidity and mortality. The main objective of this study was to identify the primary diagnoses and corresponding surgical techniques developed at the Center for the Treatment of Skin Diseases (CETEP) between 1996 and 2019, while assessing clinical and demographic aspects. A retrospective, observational study was conducted, including all patients with cutaneous lesions and subsequent surgical resolution of the same. In the analyzed sample (N 6659), there was a predominance of females (68%), and the mean age was 53 ± 21 years. The majority of patients resided in Montevideo (58%). Benign tumors were the most prevalent (41%), followed by malignant tumors (28%), with the latter comprising basal cell carcinoma (BCC) at 66%, squamous cell carcinoma (SCC) at 21%, and melanoma (MM) at 5%. The performed surgical techniques included conventional surgeries (57%), primarily using the lozenge method (93%), followed by dermatologic surgery procedures (42%), with a predominance of biopsies (52%) and shave excision with electrocoagulation (23%). It is noteworthy that CETEP resolved a greater number of patients from external centers than from its own hospital, Pereira Rossell Hospital Center (CHPR). 59% non-CHPR vs. 41% CHPR. In conclusion, this study provided national information on the epidemiology of various cutaneous tumors, as well as the most commonly employed surgical techniques in their resolution Furthermore, it emphasized the importance of dermatologic surgery and highlighted the capacity of CETEP to respond to both its own patients and those referred from other centers within the public healthcare system.

Os tumores da pele apresentam alta prevalência na dermatologia em todo mundo, sendo os tumores benignos mais frequentes que os malignos, porém estes últimos são mais estudados devido à sua morbidade e mortalidade. O objetivo principal deste estudo foi conhecer os principais diagnósticos e correspondentes técnicas cirúrgicas desenvolvidas no Centro de Tratamento de Doenças da Pele (CETEP) no período 1996-2019, avaliando aspectos clínicos e demográficos. Foi realizado um estudo retrospectivo e observacional, que incluiu todos os pacientes com lesões cutâneas e com posterior tratamento cirúrgico. Foram estudados 659 pacientes com predomínio do sexo feminino (68%) e média de idade de 53 ± 21 anos. A maioria dos pacientes residiam em Montevidéu (58%). Os tumores benignos foram os mais frequentes (41%), seguidos dos tumores malignos (28%), entre estes: carcinoma basocelular (CBC) 66%, carcinoma espinocelular (CEC) 21% e melanoma (MM) 5%. As técnicas cirúrgicas realizadas foram cirurgias convencionais (57%), principalmente em forma de cunha (93%), seguidas de procedimentos cirúrgicos dermatológicos (42%), predominando biópsias (52%) e shaving com eletrocoagulação (23%). Destaca-se que o CETEP atendeu um número maior de pacientes de centros externos do que do próprio Centro Hospitalar Pereira Rossell (CHPR): 59% não-CHPR vs. 41% CHPR. Concluindo, este trabalho forneceu informações sobre a epidemiologia dos diferentes tumores de pele no país, bem como as técnicas cirúrgicas mais utilizadas no seu tratamento. Além disso, estabeleceu a importância da cirurgia dermatológica e a capacidade do CETEP de atender os pacientes do hospital e também os que foram encaminhados de outros centros da rede pública.

Mastocitoma felino. Reporte de caso / Feline mastocytoma. Case report

RESUMEN Los mastocitomas son tumores originarios de los mastocitos que usualmente afectan a los perros y los gatos. Pueden llegar a tener un comportamiento benigno, sin embargo, esto dependerá del grado de la neoplasia y su estadiaje. En felinos, clínicamente se han descrito dos patrones: visceral y cutáneo, de los cuales el cutáneo es el más frecuente, llegando a causar metástasis a órganos adyacentes e incluso afectar el bazo y/o intestino en estadios más diferenciados. Se presenta un caso de mastocitoma felino correspondiente a un ejemplar mestizo con cuadro clínico de inicio de más de dos meses de evolución, consistente en la aparición de una placa alopécica ulcerada y elevada en región interescapular, acompañada de prurito que presentó resolución espontánea. Mediante el curso clínico se imnunizó contra el virus de la rabia, posteriormente, se observó la aparición de una lesión nodular subcutánea de características inusuales de 2cm de diámetro. Acorde con el tiempo de evolución y el antecedente vacunal se decidió la realización de biopsia y resección quirúrgica. El reporte de la biopsia confirmó diagnóstico de mastocitoma grado histológico 3 de Patnaik, teniendo en cuenta las características histológicas, estructurales y su comportamiento clínico. Se realizó seguimiento del caso pasados ocho meses, donde se evidenció mejoría del cuadro clínico, sin aparición de nueva masa sugestiva de neoplasia, sin hallazgos de metástasis a otras estructuras, con cicatrización exitosa de herida quirúrgica y evolución satisfactoria.

ABSTRACT Mast cells are tumors originating from mast cells which usually affect cats and dogs. They may have benign behavior, however, this will depend on the degree of the neo-plasm and its staging. In cats, two patterns have been described clinically: visceral and cutaneous, of which the cutaneous form is the most frequent, reaching metastasis to adjacent organs and even affecting the spleen and / or intestine in more differentiated stages. A case of a mastocytoma is presented, a feline corresponding to a mongrel specimen with a clinical picture of onset of more than two months of evolution, consisting of the appearance of an allopecal plaque, ulcerated and elevated in the interscapular region, accompanied by pruritus that presented spontaneous resolution. Through the clinical course, he was immunized against the rabies virus, later the appearance of a nodular lesion of unusual subcutaneous characteristics, 2 cm in diameter, was observed. According to the evolution time and the vaccination history, it was decided to perform a biopsy and surgical resection. The biopsy report confirmed the diagnosis of Patnaik's histological grade 3 mastocytoma, taking into account the histological and structural characteristics and its clinical behavior. The case was followed up after eight months, where an improvement in the clinical picture was evident, without the appearance of a new mass suggestive of neoplasia, without metastatic findings to other structures, with successful healing of the surgical wound and satisfactory evolution.

Canine cutaneous neoplasms in the metropolitan region of Goiânia, Goiás state, Brazil / Neoplasias cutâneas caninas na região metropolitana de Goiânia, Goiás, Brasil

ABSTRACT: The present study aimed to describe the occurrence and epidemiological features of skin neoplasms diagnosed in dogs in the metropolitan region of Goiânia, Goiás state, Brazil. Diagnoses from dog biopsies from 2011 to 2016 provided by a private veterinary pathology laboratory were analyzed. The main diagnoses were mast cell tumor, hemangiosarcoma, squamous cell carcinoma, malignant melanoma, and hemangioma. Highest frequency of neoplasms was found in female dogs, dogs aged > 8 years, and purebred dogs, particularly the American Pit Bull Terriers and the Poodles. Most common sites affected by the neoplasms were the limb and the head. Using multiple correspondence analysis, groups of neoplasms were found to be associated with different epidemiological features and the size of the neoplasms was associated with the biological behavior. The results of this study described predispositions and verified the importance of different types of skin neoplasms in dogs in the region being studied.(AU)

O objetivo deste estudo foi determinar a prevalência e as características epidemiológicas das neoplasias cutâneas em cães na região metropolitana de Goiânia, Goiás. Foram analisados os diagnósticos de um laboratório do setor privado de 2011 a 2016. Mastocitoma, hemangiossarcoma, carcinoma de células escamosas, melanoma maligno e hemangioma representaram os principais diagnósticos. A maioria dos casos ocorreram em cães de raças definidas, fêmeas e com idade >8 anos. American Pit Bull Terrier e Poodle foram as raças mais encontradas. As neoplasias acometeram principalmente regiões de membros e cabeça. Pela análise de correspondência múltipla, associou-se os grupos de neoplasias com diferentes características epidemiológicas e o tamanho da neoplasia com o comportamento biológico. A comparação dos resultados com pesquisas prévias possibilitou confirmar predisposições previamente descritas e verificar a importância dos diferentes tipos de neoplasias cutâneas em cães na região estudada.(AU)

Epidemiology of tumors in dogs in the capital of the state of Mexico from 2002-2016 / Epidemiologia de tumores em cães da capital do Estado do México durante o período de 2002-2016

A retrospective and cross-sectional study of canine tumors was performed in the capital of State of Mexico from 2002-2016. Since then, 393 tumors were remitted. Descriptive epidemiology was made from all data: breed, age, sex, and tumor features. Then the risk association between cutaneous and non-cutaneous tumors with variables such as sex, breed, and age were analyzed through an exact Fisher test and Odds ratio. In addition, some characteristics of the canine population were studied under a survey. Of all tumors, skin tumors were the most frequent (59.0%). The group of tumors related to ultraviolet radiation was the most common (15.1%). The frequency of tumors in females was 53%, nevertheless, males had more risk to develop cutaneous tumors (OR=1.88, 1.24-2.84) (0.003). The Pure breeds were the most common (82.5%) and the most frequent age range was > 7 years (54.7%). The survey showed that males (53%) and the age range 1-7 years (62.1%) were the most frequent. Conclusions, age, breed, and sex were identified as the major risk factors for tumorigenesis. Likewise, skin tumors were associated with exposure to ultraviolet radiation, probably to the height of the locality (2667mamls).(AU)

Um estudo retrospectivo e transversal dos tumores caninos foi realizado na capital do Estado do México durante o período de 2002-2016. Desde esse período, 393 tumores foram remetidos. Epidemiologia descritiva foi feita com base em todos os dados: raça, idade, sexo e características do tumor. Em seguida, a associação de risco entre tumores cutâneos e não cutâneos com variáveis como sexo, raça e idade foi analisada por meio do teste exato de Fisher e odds ratio. Além disso, algumas características da população canina foram estudadas em uma pesquisa. De todos os tumores, os de pele foram os mais frequentes (59,0%). O grupo de tumores relacionados à radiação ultravioleta foi o mais comum (15,1%). A frequência de tumores no sexo feminino foi de 53%, no entanto os machos apresentaram maior risco de desenvolver tumores cutâneos (OR = 1,88; 1,24-2,84) (0,003). As raças puras foram as mais comuns (82,5%), e a faixa etária mais frequente foi >7 anos (54,7%). A pesquisa mostrou que os machos (53%) e a faixa etária de um a sete anos (62,1%) foram os mais frequentes. Conclusões: idade, raça e sexo foram identificados como os principais fatores de risco para a tumorigênese. Da mesma forma, os tumores cutâneos foram associados à exposição à radiação ultravioleta, provavelmente até a altura da localidade (2667m ANM).(AU)

Características clínicas, histopatológicas e imuno-histoquímicas do mastocitoma cutâneo equino: relato de caso / Clinical, histopathological and immunohistochemical chacteristics ofequine cutaneous mastocytoma: case report

Uma égua puro sangue árabe, com 3 anos de idade, pertencente ao rebanho experimental da FMVZ-USP apresentou lesões tumorais cutâneas nos membros pélvicos direito e esquerdo com aproximadamente um ano de evolução. Notou-se nova formação cutânea com crescimento rápido na região do pescoço, e desde então, as lesões dos membros ganharam características inflamatórias. Foi realizada punção aspirativa da lesão do pescoço para análise citológica, em que se identificou infiltrado eosinofílico. Optou-se pelo início de tratamento conservativo com três infiltrações intralesionais consecutivas com corticoesteroide. A partir da falta de sucesso das infiltrações foram realizadas as excisões cirúrgicas totais dos nódulos do pescoço, membro pélvico direito e esquerdo. Todos os materiais obtidos dos procedimentos cirúrgicos foram enviados para avaliação histopatológica e imuno-histoquímica, nas quais se confirmou o diagnóstico de mastocitoma cutâneo. O animal recebeu alta após a cicatrização das feridas cirúrgicas e remissão dos sinais, e não demonstrou recidivas ou outras complicações advindas das lesões tumorais. Algumas neoplasias cutâneas são bem descritas e de comum ocorrência na espécie equina, como o sarcoide, melanoma, papiloma e tumor de células escamosas. Já o mastocitoma cutâneo consiste em neoplasia cutânea rara nessa espécie. Segundo a literatura, não parece existir uma predileção racial para o aparecimento deste tumor, entretanto, alguns autores citam o acometimento maior nos animais Puro Sangue Árabe. Para o estabelecimento do diagnóstico definitivo é importante a associação dos exames físico, histopatológico e imuno-histoquímico e, apesar desta neoplasia ser de raro aparecimento nos equinos, deve ser sempre considerada como diagnóstico diferencial.

A 3 year-old mare, Arab, that belongs to the experimental herd of FMVZ-USP presented cutaneous tumor lesions on right and left posterior limb with approximately one year of evolution. A new formation with rapid growth was observed on the neck region, and since then, the limbs lesion gained inflammatory characteristics. Aspirative punction was performed on the neck formation in order to submit the sample to cytological analyses, in which eosinophilic infiltrate was identified. At this point, a conservative approach was chosen with three consecutive corticoid infiltrations. With lack of success of infiltrative therapy, neck, right and left posterior limbs lesions were surgically removed. The materials obtained from surgical procedures were sent to histophatological and immunohistrochemical evaluation that confirmed cutaneous mastocytoma diagnosis. The mare was discharged after all surgical wound were healed and after full remission of clinical signs, and did not show relapses or any other complication from tumor lesions. Some cutaneous tumors are well described and commonly occur in horses, such as sarcoids, melanoma, papilloma and squamous cell carcinoma. Cutaneous mastocytoma is considered a rare cutaneous tumor in this species. According to literature, equine mastocytoma do not have breed predilection, however, some authors mention a greater involvement in Purebreed Arabian horses. In order to establish a definitive diagnosis, it is important to associate physical exams to histophatological an immunohistochemical evaluation and, even though rare in horses, this neoplasm must be considered as a differential diagnosis.

Clinical, histopathological and immunohistochemical chacteristics of equine cutaneous mastocytoma: case report / Características clínicas, histopatológicas e imuno-histoquímicas do mastocitoma cutâneo equino: relato de caso

A 3 year-old mare, Arab, that belongs to the experimental herd of FMVZ-USP presented cutaneous tumor lesions on right and left posterior limb with approximately one year of evolution. A new formation with rapid growth was observed on the neck region, and since then, the limbs lesion gained inflammatory characteristics. Aspirative punction was performed on the neck formation in order to submit the sample to cytological analyses, in which eosinophilic infiltrate was identified. At this point, a conservative approach was chosen with three consecutive corticoid infiltrations. With lack of success of infiltrative therapy, neck, right and left posterior limbs lesions were surgically removed. The material obtained from surgical procedures were sent to histophatological and immunohistrochemical evaluation, that confirmed cutaneous mastocytoma diagnosis. The mare was discharged after all surgical wound were healed and after full remission of clinical signs, and did not show relapses or any other complication from tumor lesions. Some cutaneous tumors are well described and commonly occur in horses, such as sarcoids, melanoma, papilloma and squamous cell carcinoma. Cutaneous mastocytoma is considered a rare cutaneous tumor in this species. According to literature, equine mastocytoma do not have breed predilection, however, some authors mention a greater involvement in Purebreed Arabian horses. In order to establish a definitive diagnosis, it is important to associate physical exams to histophatological an immunohistochemical evaluation and, even though rare in horses, this neoplasm must be considered as a differential diagnosis.

Uma égua puro sangue árabe, com 3 anos de idade, pertencente ao rebanho experimental da FMVZ-USP apresentou lesões tumorais cutâneas nos membros pélvicos direito e esquerdo com aproximadamente um ano de evolução. Notou-se nova formação cutânea com crescimento rápido na região do pescoço, e desde então, as lesões dos membros ganharam características inflamatórias. Foi realizada punção aspirativa da lesão do pescoço para análise citológica, em que se identificou infiltrado eosinofílico. Optou-se pelo início de tratamento conservativo com três infiltrações intralesionais consecutivas com corticoesteroide. A partir da falta de sucesso das infiltrações foram realizadas as excisões cirúrgicas totais dos nódulos do pescoço, membro pélvico direito e esquerdo. Todos os materiais obtidos dos procedimentos cirúrgicos foram enviados para avaliação histopatológica e imuno-histoquímica, nas quais se confirmou o diagnóstico de mastocitoma cutâneo. O animal recebeu alta após a cicatrização das feridas cirúrgicas e remissão dos sinais, e não demonstrou recidivas ou outras complicações advindas das lesões tumorais. Algumas neoplasias cutâneas são bem descritas e de comum ocorrência na espécie equina, como o sarcoide, melanoma, papiloma e tumor de células escamosas. Já o mastocitoma cutâneo consiste em neoplasia cutânea rara nessa espécie. Segundo a literatura, não parece existir uma predileção racial para o aparecimento deste tumor, entretanto, alguns autores citam o acometimento maior nos animais Puro Sangue Árabe. Para o estabelecimento do diagnóstico definitivo é importante a associação dos exames físico, histopatológico e imuno-histoquímico e, apesar desta neoplasia ser de raro aparecimento nos equinos, deve ser sempre considerada como diagnóstico diferencial.

Incidence of skin tumors in dogs in Salvador, Bahia state, Brazil (2007-2016) / Frequência de dermatopatias tumorais em cães da cidade de Salvador, Bahia (2007-2016)

This study aimed to establish the incidence of skin tumors (cutaneous proliferative lesions of neoplastic or non-neoplastic nature) in dogs diagnosed by histopathological evaluation at the Veterinary Pathology Laboratory (LPV) of the Federal University of Bahia (UFBA) in a 10-year (2007-2016) historical series. Of the 1945 histopathological diagnoses made in this period, 503 were skin biopsies, and 617 dermatological problems (87 dogs, 17.3%, presented more than one positive diagnosis) were found. Of the 617 diagnoses of dermatopathy, 546 (88.49%) were tumors and 71 (11.51%) were non-tumorous alterations. The 546 conditions more profoundly studied were from 453 dogs, 468 (85.7%) neoplastic and 78 (14.3%) non-neoplastic tumors. The 468 neoplasms were classified as follows: 230 benign (49.14%), 215 malignant (45.94%), 23 borderline (epitheliomas) (4.91%), 51.92% (243/468) mesenchymal, 42.74% (200/468) epithelial, 4.91% (23/468) melanocytic, and 0.43% (2/468) metastatic (mammary gland). The most commonly diagnosed neoplastic dermatopathies were mastocytoma (14.7%) and lipoma (7.48%). Among the 78 non-neoplastic conditions (14.3%), epidermal inclusion cyst (39.74%) and trichogranuloma (15.38%) were the most frequent. Canine dermatopathies accounted for 26% of the biopsy files of the LPV-UFBA. Distinct simultaneous dermatological problems were frequently found in the dogs assessed (one in six). Considering that these conditions can present with different cellular origin and biological behavior, it is crucial that histopathological evaluation be performed in fragments from the different cutaneous lesions.(AU)

Objetivou-se com esse estudo determinar a frequência de dermatopatias tumorais (lesões proliferativas cutâneas que cursam com aumento de volume de natureza neoplásicas ou não neoplásicas) em cães, diagnosticadas por exame histopatológico no Laboratório de Patologia Veterinária (LPV) da Universidade Federal da Bahia (UFBA) na série histórica de 10 anos (2007-2016). Dos 1.945 exames histopatológicos realizados no período, 503 tratava-se de biópsias cutâneas, dentre os quais, foram diagnosticados 617 dermatopatias (87 cães, 17,3%, apresentavam mais de um diagnóstico). Dos 617 diagnósticos de dermatopatias 546 (88,49%) foram tumorais e 71 (11,51%) não tumorais. As 546 dermatopatias tumorais, estudadas com mais ênfase, foram diagnosticadas em 453 cães, 468 (85,7%) eram neoplásicas e 78 (14,3%) não neoplásicas. Das 468 dermatopatias tumorais neoplásicas encontradas 230 foram benignas (49,14%), 215 malignas (45,94%), 23 borderline/epiteliomas (4,91%), 51,92% (243/468) de origem mesenquimal, 42,74% (200/468) epiteliais, 4,91% (23/468) melanocíticas e 0,43% (2/468) metastáticas para a pele (primárias de glândula mamária). As dermatopatias neoplásicas mais diagnosticadas foram o mastocitoma (14,7%) e o lipoma (7,48%). Dentre as 78 dermatopatias tumorais não neoplásicas (14,3%), os cistos de inclusão epidermal (39,74%) e o tricogranuloma (15,38%) foram os mais frequentes. As dermatopatias caninas representaram 26% da casuística no LPV/UFBA. A ocorrência de dermatopatias tumorais simultâneas distintas foi comum nos cães desse estudo (um a cada seis); como podem ter origens celulares e comportamentos biológicos diferentes, enfatiza-se a importância da coleta e envio para exame histopatológico de fragmentos das diferentes lesões cutâneas.(AU)

Spectrum of malignant skin adnexal tumors – a single institution study of 17 cases with clinicopathological correlation.

Background: Skin adnexal tumors are a rare, assorted group of tumors with differentiation towards hair follicle, sebaceous glands or sweat glands. A vast majority of them are benign. But for every benign adnexal tumor, a malignant counterpart exists. Many histological subtypes of these malignant tumors been described, but only in short series or individual case reports. So, not much is known about their incidence or prognosis simply because of the limited number of cases available for analysis. This study was undertaken to contribute towards this less traversed area of dermatopathology. Methods: In the present study, a total of 60 cases with a histopathological diagnosis of skin adnexal tumors were studied. The slides and blocks were retrieved from the archives and were reviewed and were reclassified and subtyped as per WHO classification of skin tumors, 2006. Results: Among the 60 cases of adnexal tumors documented and reviewed over the four year study period, 17 cases of malignant adnexal tumors were encountered. Of these, 10 (58%) were tumors with eccrine or apocrine differentiation, 5 (29%) were of follicular differentiation and two (12%) were of sebaceous differentiation. Mammary paget disease (MPD) was the most frequent malignant tumor encountered both overall and among the tumors with eccrine and apocrine differentiation. Other tumors encountered in their order of frequency were Malignant proliferating trichelemmal tumor, apocrine carcinoma, sebaceous carcinoma and extramammary paget disease, trichelemmal carcinoma and eccrine carcinoma. These tumors were evaluated with regard to their age, site, gender distribution, clinical characters and histopathological features. Conclusion: Malignant adnexal tumors are extremely rare with indistinct clinical characteristics. They are locally aggressive, and have the potential for nodal involvement and distant metastasis, with a poor clinical outcome. A high index of suspicion is necessary to establish a diagnosis in most cases.

Surgical Treatment of 846 Patients with Benign Skin Tumors: Experience of a Dermatologic Surgeon in Korea / 대한피부과학회지

BACKGROUND: The incidence of skin tumors has been increasing over the past few years due to an aging population, environmental changes, and improved access to medical institutions. OBJECTIVE: To report the rate of relapse and complications after surgical treatment, and suggest appropriate ways of treating benign skin tumors. METHODS: We performed a retrospective review of 846 patients with benign skin tumors who were diagnosed and treated by a single dermatosurgeon. RESULTS: Of the 846 patients, 18 (2.1%) developed local recurrence. Epidermal cysts (15/390) were the most common skin condition, followed by lipomas (2/149). The recurrence rate of epidermal cysts showed no statistical difference when treatment options and the presence of inflammation or suppuration at the first visit were considered. Six patients (0.7%, 6/846) had one of the complications such as persistent inflammation over one month, severe pain, secondary infection, or skin necrosis. All the lipomas following recurrence or those with complications were located in the intramuscular or submuscular area of the forehead, which were easily localized by sonography. CONCLUSION: Surgery is a valuable method for the treatment of benign skin tumors with low rates of complication and relapse. For better outcomes after treatment, dermatologists should attempt to remove these tumors completely and consider the use of imaging studies before treatment.

Ressecção alargada no tratamento do dermatofibrossarcoma protuberante / Extended resection for treatment of dermatofibrosarcoma protuberans

INTRODUÇÃO: Dermatofibrossarcoma Protuberante (DFSP) é um tumor de pele raro e de malignidade intermediária, com baixo potencial metastático, mas alta taxa de recorrência após tratamento cirúrgico. O tratamento clássico é a ressecção alargada, com margens variáveis. Muitos trabalhos descreveram os resultados da cirurgia micrográfica de Mohs no tratamento desta afecção. O objetivo deste estudo retrospectivo é verificar se a ressecção alargada constitui um método confiável no tratamento do DFSP. MÉTODO: Entre agosto de 1968 e setembro de 2013, 31 lesões foram ressecadas em 30 pacientes com DFSP. Todos os pacientes foram submetidos à excisão cirúrgica radical, com remoção de 3 cm de tecido sadio nas margens laterais e com a margem profunda incluindo uma estrutura anatômica não infiltrada pelo tumor. Os seguintes aspectos foram estudados: gênero, idade, local da lesão, tratamento prévio e características peculiares da proservação. RESULTADOS: Dezenove (63,3%) pacientes eram do sexo masculino e 11 (37,7%), do feminino. A média de idade da apresentação foi de 40,9 anos. As lesões estavam localizadas em tronco (61,3%), cabeça (22,6%), membros superiores (6,4%), membros inferiores (6,4%) e pescoço (3,3%). Tratamento prévio não foi observado em 58,1% dos pacientes. Um paciente (3,3%) evoluiu com recidivas e óbito, em decorrência do tratamento cirúrgico; três (10,0%) faleceram por outras causas. CONCLUSÕES: A ressecção alargada com margens de 3 cm, com remoção de estrutura anatômica sadia, constitui método eficiente no tratamento do DFSP.

INTRODUCTION: Dermatofibrosarcoma protuberans (DFSP) is a rare skin tumor with intermediate malignancy and low metastatic potential, but a high recurrence rate after surgical treatment. The classical treatment is extended resection with varying margins. Many studies have described Mohs micrographic surgery for treatment of this disease. This retrospective study was to verify if extended resection is a reliable DFSP treatment method. METHOD: A total of 31 lesions were resected in 30 patients with DFSP between August 1968 and September 2013. All patients underwent radical surgical excision, with removal of 3 cm of healthy tissue on the lateral margins and with deep margin including an anatomical structure without tumor infiltration. Analyzed patient characteristics included sex, age, tumor site, previous treatment, and peculiar characteristics observed during the follow-up period. RESULTS: Nineteen (63.3%) patients were male and 11 (37.7%) female. Their average age at tumor presentation was 40.9 years. The tumors were located on the trunk (61.3%), head (226%), upper limbs (6.4%), lower limbs (6.4%), and neck (3.3%). No previous treatment was reported in 58.1% of the patients. One patient (3.3%) developed recurrence and died due to the surgical treatment; three patients (10.0%) died from other causes. CONCLUSIONS: Extended resection with 3-cm margins and removal of healthy anatomical structures is an effective treatment for DFSP.

The Expression of beta-defensin 1 in Various Skin Tumors / 대한피부과학회지

BACKGROUND: Among antimicrobial peptides produced by keratinocytes, beta-defensins and LL-37 are the major human antimicrobial peptides. Because beta-defensins have recently received great attention for its roles associated with host defense and cancer development, we hypothesized that beta-defensin 1 has an influence on the differentiation and malignant changes of various skin tumors originating from keratinocytes and malignant melanomas. OBJECTIVE: This study was conducted to measure the expression of beta-defensin 1 in different skin tumors. METHODS: The expression of beta-defensin 1 was examined by immunohistochemical staining of 57 specimens of skin tumors including 12 cases of seborrheic keratosis, 4 cases of keratoacanthoma, 12 cases of actinic keratosis, 10 cases of basal cell carcinoma, 16 cases of squamous cell carcinoma and 3 cases of malignant melanoma. RESULTS: Immunohistochemical analysis of skin tumor tissue samples revealed significantly higher expression of beta-defensin 1 in benign skin tumors (seborrheic keratoses, keratoacanthomas) and premalignant lesions (actinic keratoses) than in malignant tumors (squamous cell carcinomas, basal cell carcinomas, and malignant melanomas). Among malignant tumors, basal cell carcinomas and malignant melanomas showed lower expression of beta-defensin 1 than squamous cell carcinomas, in which their expression was shown to be decreased with increased dysplasia of the tumor cells. CONCLUSION: These findings showed that beta-defensin 1 has a negative association with malignancies of skin tumors. The role of beta-defensin 1 is suggested in the protection of malignant changes including loss of differentiation and dysplasia in skin tumors.

Practical immunohistochemistry of epithelial skin tumor.

Skin tumors are tumors arising from keratinocyte and from adnexal structures. Immunohistochemistry is very helpful in diagnosis of difficult cases in epithelial skin neoplasms, especially basal cell carcinoma (BCC) which is positive for BerEP4, a keratin marker, and mostly negative for epithelial membrane antigen (EMA). Squamous cell carcinoma cells are positive for EMA and cytokeratin, which are of higher molecular weight than those found in BCC. In contrast to BCC, trichoblastoma and trichoepithelioma are negative for androgen receptors. Of the malignant dermal spindle cell lesions, spindle cell squamous carcinoma is positive to 34 betaE12, desmoplasmic melanoma is positive to S100, and leiomyosarcoma is positive to desmin. Of the malignant pagetoid cells, Paget's disease is positive to CK7 and cam5.2, whereas the pagetoid variant of Bowen's disease is positive to CK 5/6. Melanoma in-situ is positive to both S100 and melan-A. Immunohistochemistry is an extremely valuable adjunct to standard morphologic diagnosis in diagnostic pathology. Diagnosis of epithelial tumor depends largely on morphological features but, in rare cases, immunohistochemical stains are needed for definitive diagnosis.

Estudio de la sensibilidad y especificidad diagnóstica del microscopio confocal de reflectancia (MCR) en lesiones tumorales de la piel / Diagnostic sensitivity and specificity of the Reflectance Confocal Laser Microscope (RCLM) in tumors of the skin

Introducción: El Microscopio Láser Confocal de Reflectancia (MCR) es una técnica no invasiva, con resolución cuasi histológica, que permite la visualización de células y estructuras de la piel. Esta tecnología es especialmente útil en el diagnóstico de lesiones tumorales. Material y métodos: Se trata de un estudio retrospectivo que busca medir la sensibilidad y especificidad del MCR en el diagnóstico de lesiones tumorales de la piel. Luego de obtener imágenes con el MCR de las lesiones, éstas se resecaron y se enviaron a estudio histopatológico, observando la correlación entre ambas técnicas. Resultados: Encontramos un 98 por ciento de concordancia entre el diagnóstico por MCR y el diagnóstico histopatológico para el total de tumores. El MCR mostró una sensibilidad y especificidad de 100 por ciento paramelanomas y sensibilidad de 93 por ciento y especificidad de 100 por ciento para carcinoma basocelular. En el caso de nevus atípico, la sensibilidad fue de 100 por ciento y la especificidad de 97 por ciento. Sólo dos lesiones que en la histopatología demostraron ser carcinomas basocelulares superficial y nodular fueron confundidas conqueratosis liquenoide y nevus atípico respectivamente. Discusión: Este estudio demostró una alta concordancia entre el MCR y la histopatología en tumores malignos. Sin duda que el MCR es y seguirá siendo un pilar fundamental en el diagnóstico de las lesiones tumorales de la piel, así como en la investigación y seguimiento in vivo de diversas lesiones de la piel.

Introduction: The Reflectance Confocal Laser Microscope (RCLM) is a new non-invasive technology, with quasi-histological resolution, which allows visualization of cells and skin structures and is particularly useful in the diagnosis of skin tumors. Material and methods: This is a retrospective study aimed to determine the diagnostic sensitivity and specificity of the RCLM in tumors of the skin using conventional histology as the gold standard for diagnosis. The images were obtained from patients with tumors of the skin using the RCLM, which were subsequently excised and sent to histopathological analysis. Results: We found a 98 percent concordance between the previous diagnosis by RCLM and pathology results. Diagnosis by confocal microscopy showed a sensitivity and specificity of 100 percent for melanomas, 93 percent sensitivity and 100 percent specificity for basal cell carcinoma and a sensitivity of 100 percent and specificity of 97 percent for atypical nevi. Only 2 lesions on histopathology proved to be superficial and nodular basal cell carcinomas were confused with lichenoid keratosis and atypical nevi, respectively. Discussion: We believe that RCLM is and will remain a really useful tool in the diagnosis of tumours of the skin as well as in research and in vivo monitoring of various types of skin lesion.

Dermatoscopy of non-melanocytic skin tumors.

Dermatoscopy is a cheap and non-invasive diagnostic technique that improves the diagnostic accuracy of non-pigmented benign and malignant skin tumors. Dermatologist should be aware of dermatoscopic features of non-melanocytic skin tumors to reach the correct diagnosis.

Aspectos epidemiológicos e distribuição anatômica das diferentes formas clínicas do sarcoide equino no Rio Grande do Sul: 40 casos / Epidemiological aspects and anatomic distribuition of equine sarcoid in the state of Rio Grande do Sul, Brazil: 40 cases

The files of histopathological exams carried out by the Laboratório de Patologia Veterinária of the Universidade Federal de Santa Maria (LPV-UFSM), between January 2000 and March 2010, were reviewed in search of cases of equine sarcoid. Forty cases were selected to determine epidemiological aspects and anatomical distribution of the various clinical forms of these neoplasms in horses from Rio Grande do Sul. Out of the cases in which the ages were registered in the histopathological reports, 73.0 percent (27/37) were 1 to 5-year-old horses. Multiple sarcoids were observed in most of the affected horses (29/40 [72.5 percent]). The fibroblastic form was most frequently observed and occurred in 42.2 percent (27/64) of the cases. In more than half of the cases (22/40 [55.0 percent]), sarcoids had a multifocal distribution. Twenty two (55 percent) out of the 40 horses evaluated had the tumors in the limbs.

Foram revisados todos os protocolos de exames histopatológicos, arquivados no Laboratório de Patologia Veterinária da Universidade Federal de Santa Maria (LPV-UFSM), realizados entre janeiro de 2000 e março de 2010, na busca de casos de sarcoide equino. Quarenta casos foram selecionados com o objetivo de determinar os aspectos epidemiológicos e a distribuição anatômica das diferentes formas clínicas deste tumor em equinos no Rio Grande do Sul. Dos casos que tiveram suas idades anotadas nos protocolos, 73,0 por cento (27/37) eram de equinos entre 1 e 5 anos de idade. Múltiplos sarcoides foram observados na maioria dos equinos afetados (29/40 [72,5 por cento]). A forma clínica mais observada foi a fibroblástica, que ocorreu em 42,2 por cento (27/64) dos casos. Em mais da metade dos casos (22/40 [55,0 por cento]), os sarcoides tinham distribuição multifocal. Equinos que apresentavam tumores nos membros totalizaram 22 dos 40 (55 por cento) casos analisados.

Sarcoma de Kaposi clássico fatal / Fatal outcome in classic Kaposi's sarcoma

Descrito em 1872, o sarcoma de Kaposi é neoplasia multicêntrica rara originária de células endoteliais com manifestação cutânea e extracutânea. A forma clássica é muito mais frequente em homens idosos, com evolução prolongada e boa resposta a quimioterapia e radioterapia. Apresentaremos um caso de sarcoma de Kaposi clássico com comprometimento cutâneo e visceral em paciente do sexo feminino com rápida evolução fatal.

First described in 1872, Kaposi's sarcoma is defined as a rare multifocal tumor that originates in the endothelial cells and presents with cutaneous and extracutaneous manifestations. The classic form is most common in elderly men and progression is slow. This tumor responds well to chemotherapy and radiotherapy. This report describes a classic case of Kaposi's sarcoma in a woman with skin and visceral manifestations in whom the disease rapidly progressed to a fatal outcome.

Emission fi lter design to detect poultry skin tumorsusing fl uorescence hyperspectral imaging / Diseño del filtro de emisión para detectar tumores cutáneos en canales de aves usandoimagenes de fluorescencia hiperespectral / Desenho de um filtro de emissão para detectar tumores cutâneos em carcaças de avesusando imagens de fluorescência hiperespectral

This paper presents an optimal emission filter of the fluorescence imaging system to detect skintumors on poultry carcasses. The secure production of disease-free meat is crucial in the mass productionenvironment. The fluorescence spectra have been gaining the practical use in many areas because thefluorescence response is very sensitive in detecting trace elements. The spectral features of the specimenare embedded across broad spectral bands and have been analyzed in various methods. We apply thelinear discriminant analysis to determine the emission filter of fluorescence imaging system. It providesthe optimal attenuation of emission wavelengths in terms of discriminant power. The attenuation valuesprioritize wavelengths to select significant spectral bands. With the optimal filter, skin tumor parts ofchicken carcasses are enhanced saliently in resultant fluorescence images.

La producción de carne libre de enfermedades es crucial en producción pecuaria intensiva. Losespectros de fluorescencia se han estado usando en forma práctica en muchas áreas, ya que la respuestade fluorescencia es muy sensible para detectar elementos traza. Este artículo presenta un óptimo filtrode emisión para el sistema de imágenes de fluorescencia utilizado para detectar tumores cutáneos encanales de pollo. Las características espectrales de la muestra --insertas en bandas espectrales amplias- sehan analizado por varias metodologías. En este artículo aplicamos el análisis lineal discriminante paradeterminar el filtro de emisión del sistema de imágenes por fluorescencia, mediante el cual se obtiene laatenuación optima de las ondas de emisión en términos de poder discriminante. Los valores de atenuaciónpriorizan las longitudes de onda para seleccionar las bandas espectrales más significativas. Gracias a lautilización de este filtro optimizado, los tumores cutáneos existentes en la canal de pollo son magnificados,de modo que se alcanzan a diferenciar perfectamente en las imágenes de fluorescencia resultantes.

A produção de carne livre de doenças é crucial em produção pecuária intensiva. Os espectros defluorescência temse estado utilizando em forma prática em muitas áreas, já que a resposta da fluorescênciaé muito sensível para detectar elementos traça. Este artículo apresenta um óptimo filtro de emissão parao sistema de imagens de fluorescência utilizado para detectar tumores cutâneos em carcaças de frangos.As características espectrais da amostra, insertas em bandas espectrais amplas são utilizadas por variasmetodologias. Neste artículo aplicamos a análises linear discriminante para determinar o filtro de emissãodo sistema de imagens por fluorescência, mediante o qual obtém-se a atenuação óptima das ondas deemissão em termos de poder discriminante. Os valores de atenuação dão prioridade às longitudes deonda para seleccionar as bandas espectrais mais significativas. Graças à utilização do filtro optimizado,os tumores cutâneos existentes na carcaça de frango são magnificados, de fato que são diferenciadosperfeitamente nas imagens de fluorescência resultantes.

Expression of p63 and Cyclooxygenase-2 and Their Correlation in Skin Tumors / 华中科技大学学报（医学）（英德文版）

To study the expression of p63 and cyclooxygenase-2 (cox-2) in skin tumors and evaluate the correlation between p63 and cox-2, the expressions of cox-2 and p63 were measured by streptavidin-peroxidase complex immunohistochemical technique in 17 cases of skin squamous cell carcinoma (SCC), 19 cases of Bowen's disease(Bowen), 11 cases of actinic keratosis(AK), 12 cases of seborreic keratosis(SK) and 13 specimens of normal skin. Our results showed that the expression of p63 in skin squamous cell carcinoma, Bowen's disease and actinic keratosis were significantly higher than that in seborreic keratosis, while the expression of p63 in seborreic keratosis was significantly higher than that in normal skin. The expression of cox-2 in skin squamous cell carcinoma,Bowen's disease and actinic keratosis were significantly higher than that in seborreic keratosis, while no statistical difference was noted in the expression of cox-2 between seborreic keratosis and normal skin. Cox-2 expression was positively correlated with the high p63 expression in malignant skin tumors. The increased expression of cox-2 and p63 may play an important role in the development of skin tumors and work synergetically in malignant skin tumors.

A Study of Skin Tumors in the Jeonbuk Province Over the Last 27 Years (1978~2004) / 대한피부과학회지

BACKGROUND: There have been many changes to the social and medical environment in Korea over the last 30 years. Therefore, we presume that distribution and incidence of skin tumors might have changed. This is the first report to analyse skin tumors in the Jeonbuk province over the past 27 years (1978~2004). OBJECTIVE: To investigate the incidence and distribution of skin tumors among people of the Jeonbuk province. METHODS: A total of 4,037 cases of skin tumor were obtained from surgical pathology specimen at Department of Dermatology in Chonbuk National University Hospital. RESULTS: Among the 4,037 cases of skin tumors, 2,856 cases (70.8%) were benign tumors, 841 cases (20.8%) were malignant tumors, and 340 cases (8.4%) were premalignant lesions. The most common benign skin tumor was melanocytic nevi with 402 cases, followed by 299 cases of seborrheic keratosis, 298 cases of epidermal cyst, and 136 cases of nevus sebaceus. Among the 841 cases of malignant skin tumors, there were 309 cases of basal cell carcinoma, 192 cases of squamous cell carcinoma, 66 cases of malignant melanoma, and 55 cases of malignant lymphoma. Of the premalignant lesions, there were 271 cases of actinic keratosis, 67 cases of Bowen's disease and 2 cases of lentigo maligna. The predilection sites of melanocytic nevi were the face (50.0%), trunk (13.9%), scalp (11.0%), foot (9.5%), and those of seborrheic keratosis were the face (37.5%), followed by the scalp (23.1%). The predilection site of basal cell carcinoma, squamous cell carcinoma and actinic keratosis was the face (86.9%, 57.8%, 82.3%). Over the past 10 years (1994~2004), benign tumors, malignant tumors and premalignant lesions have occurred with a ratio of 58.4%, 68.7%, and 77.2% respectively. 220 patients with malignant tumors were transferred for treatment or evaluation to other departments or hospitals. Form these, the most common type of tumor was basal cell carcinoma (56 cases), followed by squamous cell carcinoma (44 cases). CONCLUSION: We reviewed 4,037 cases of skin tumor, confirmed histopathologically within at the Department of Dermatology at the Chonbuk National University Hospital between 1978 and 2004. This data will be made available for the study of skin tumors in Korea.

A Statistical Survey on 1448 Skin Tumors for the Recent 10 Years / 대한피부과학회지

BACKGROUND: Many studies focused on the distribution of skin tumors in Korea, but none of them included whole data refered from deparments other than dermatology and primary physicians. OBJECTIVE: This study was to investigate the incidence and distribution of skin tumors among Korean people. METHODS: A study was made on 1448 cases of skin tumors which were obtained mainly from surgical pathology specimen during the period of 10 years from 1992 to 2001 at Department of Dermatology in Keimyung University Dongsan Medical center. RESULTS: 1. Of the 1448 cases of skin tumors, 1171 cases(80.9%) were benign tumor, 277 cases (19.1%) were malignant tumor and male to female ratio was 1: 1.1. 2. Among the 1171 cases of benign tumors, 174 cases of melanocytic nevi, 173 cases of epidermal cyst, 109 cases of seborrheic keratosis, 62 cases of granuloma pyogenicum were noted. 3. Among 277 cases of malignant tumors, 107 cases of basal cell carcinoma, 58 cases of squamous cell carcinoma, 27 cases of metastatic cutaneous carcinoma, 24 cases of Bowen disease were noted. 4. The predilection sites of Intradermal nevi were face(38.4%), trunk(17.4%), scalp(16.3%), and those of epidermal cyst were face(41.0%), trunk(29.5%), neck(8.1%). The predilection site of basal cell carcinoma, squamous cell carcinoma was face(80.4%, 58.6%). CONCLUSION: The 1448 cases of skin tumors, which were confirmed histologically from surgical pathology specimen at Department of Dermatology in the Keimyung University Dongsan Medical Center during the period of 10 years from 1992 to 2001, were reviewed.