Caracterización de pacientes con cáncer de piel y otras afecciones causadas por fotodaño / Characterization of patients with skin cancer and other affections caused by photodamage

Introducción: El fotodaño es la agresión producida por la radiación solar en la piel. A su vez, la radiación ultravioleta es uno de los primeros agentes considerados como generadores de cáncer. Objetivo: Caracterizar a los pacientes con neoplasias cutáneas y otras afecciones causadas por fotodaño, según variables clínicas seleccionadas. Métodos: Se realizó un estudio transversal, observacional, clínico, descriptivo y retrospectivo de 64 pacientes diagnosticados con alguna afección causada por fotodaño, pertenecientes al área de salud del consultorio médico No. 11 del Policlínico Aquiles Espinosa Salgado de Las Tunas, desde enero del 2020 hasta igual periodo del 2022. Se analizaron variables, tales como edad, sexo, color de la piel, fototipo de piel, ocupación, uso regular de medios de protección solar antes de los 18 años de edad y actualmente, así como enfermedad dermatológica causada por fotodaño. Resultados: Predominaron el grupo etario de 60 años y más (43,7%), el sexo femenino (54,7 %), el color de la piel blanco (98,5 %), el fototipo de piel III (59,4 %) y los trabajadores estatales (53,1%).Se halló, que 90,6 % de los pacientes no tenían antecedentes de exposición a radiaciones no ultravioletas; 25,0 % refirió usar regularmente algún medio de protección antes de los 18 años de edad y 51,5 % lo emplean actualmente. La enfermedad dermatológica causada por fotodaño que primó fue el cáncer de piel (37,5 %). Conclusiones: Este estudio denotó la pertinencia y necesidad de identificación de las características clínicas de los pacientes con afecciones causadas por fotodaño en el consultorio médico referido.

Introduction: Photodamage is the aggression caused by solar radiation in the skin. In turn, the ultraviolet radiation is one of the first agents considered as cancer generators. Objective: Characterize the patients with cutaneous neoplasms and other affections caused by photodamage, according to selected clinical variables. Methods: A cross-sectional, observational, clinical, descriptive and retrospective study of 64 patients diagnosed with some affection caused by photodamage was carried out, belonging to the health area of the doctor office No. 11 of Achiles Espinosa Salgado Polyclinic in Las Tunas, from January, 2020 to the same period in 2022. Some variables were analyzed, such as age, sex, color of the skin, skin photo type, occupation, regular use of solar protection means before the 18 years and now, as well as dermatologic disease caused by photodamage. Results: There was a prevalence of the 60 years and over age group (43.7 %), female sex (54.7 %), color of the skin white (98.5 %), skin photo type III (59.4 %) and the state workers (53.1 %). It was found that 90.6 % of the patients didn't have history of exhibition to non ultraviolet radiations; 25.0 % referred to use some means of protection regularly before the 18 years and 51.5 % use it at the moment. The dermatologic disease caused by photodamage that prevailed was the skin cancer (37.5 %). Conclusions: This study denoted the relevance and necessity to identify the clinical characteristics of the patients with affections caused by photodamage in the doctor office abovementioned.

Caracterización clínico-epidemiológica de pacientes con daño actínico crónico. Cochabamba, Bolivia / Clinical-epidemiological characterization of patients with chronic actinic damage. Cochabamba, Bolivia

RESUMEN Introducción: el daño actínico crónico es un grupo de alteraciones en la estructura, función y apariencia de la piel como resultado de la exposición no controlada a las radiaciones ultravioletas. Puede provocar el cáncer de piel. Objetivo: caracterizar a los pacientes con daño actínico crónico, atendidos en la consulta de Dermatología del Hospital Comunitario Valle Hermoso, en el departamento de Cochabamba, Bolivia. Materiales y métodos: se realizó un estudio clínico descriptivo, prospectivo, en un universo de 1 833 pacientes diagnosticados con daño actínico crónico, atendidos en la consulta de Dermatología del Hospital Comunitario Valle Hermoso, en Cochabamba, entre septiembre de 2017 y septiembre de 2018. Se evaluaron las variables edad, sexo, color y fototipo de piel, ocupación, uso de medios de protección solar, exposición a otro tipo de radiaciones, manifestaciones clínicas de fotodaño y altitud del lugar de residencia. Resultados: predominaron el grupo de edad de 25 a 59 años, el sexo femenino, el color de piel mestizo (77,08 %), el fototipo de piel IV (76,98 %) y la ocupación comerciante (72,56 %). La mayoría de los pacientes (82,7 %) no utilizaron medios de protección solar, y el 99,8 % no tuvieron exposición a otro tipo de radiaciones. Las lesiones por fotodaño que prevalecieron fueron melasma (83,03 %) y lentigos (12,22 %). El 99,29 % vivían en zonas de gran altitud. Conclusiones: se caracterizaron los pacientes con daño actínico crónico, obteniendo en algunas variables estudiadas resultados similares a los mencionados por otros investigadores (AU).

ABSTRACT Introduction: chronic actinic damage is a group of alterations in the structure, function, and appearance of the skin as a result of uncontrolled exposure to ultraviolet radiation. It can cause skin cancer. Objective: to characterize the patients with chronic actinic damage, treated at the Dermatology consultation of Valle Hermoso Community Hospital, in the department of Cochabamba, Bolivia. Materials and methods: a descriptive, prospective clinical study was conducted in a universe of 1,833 patients diagnosed with chronic actinic damage, treated at the Dermatology clinic of the Valle Hermoso Community Hospital, Cochabamba, between September 2017 and September 2018. The variables age, sex, skin color, skin phototype, occupation, use of sun protectors, exposure to other types of radiation, clinical manifestations of photodamage and altitude of the place of residence were evaluated. Results: the age group from 25 to 59 years, the female sex, mestizo skin color (77.08 %), the IV skin phototype (76.98 %) and merchant occupation (72.56 %) predominated. Most patients (82.7 %) did not use sun protection means, and 99.8 % had no other radiation exposure. The prevailing photodamage lesions were melasma (83.03 %) and lentigo (12.22 %). 99.29 % lived in high altitude areas. Conclusions: the patients with chronic actinic damage were characterized, obtaining in some variables studied results similar to those mentioned by other researchers (AU).

A Split-Face, Single-Blinded, Randomized Controlled Comparison of 532 nm Picosecond Neodymium-Doped Yttrium Aluminum Garnet Laser versus 532 nm Q-Switched Neodymium-Doped Yttrium Aluminum Garnet Laser in the Treatment of Solar Lentigines

Bilateral Segmental Neurofibromatosis with Lentiginosis Showing a Checkerboard Pattern / 대한피부과학회지

Segmental neurofibromatosis, a subtype of neurofibromatosis type 1, is characterized by neurofibromas and/or café-au-lait spots limited to an area or segment of the body. Checkerboard pattern is a rare type of cutaneous mosaic manifestation, characterized by squares or broad ribbons of affected skin with sharp demarcation at the midline. Herein, we report the case of a patient with bilateral segmental neurofibromatosis with lentiginosis showing a checkerboard pattern. Our patient had multiple hyperpigmented macules on her entire body in a checkerboard pattern since birth. Several café-au-lait patches were observed on the left buttock and right axilla. A neurofibroma was incidentally found beneath the café-au-lait patch by histological examination, which showed ill-defined spindle cells with elongated nuclei at the deep dermis that stained positive for S-100. Based on the clinical presentation and histopathologic results, the patient was diagnosed with bilateral segmental neurofibromatosis with lentiginosis showing a checkerboard pattern.

Noonan syndrome and RASopathies: Clinical features, diagnosis and management

Noonan syndrome (NS) and NS-related disorders (cardio-facio-cutaneous syndrome, Costello syndrome, NS with multiple lentigines, or LEOPARD [lentigines, ECG conduction abnormalities, ocular hypertelorism, pulmonic stenosis, abnormal genitalia, retardation of growth and sensory neural deafness] syndrome) are collectively named as RASopathies. Clinical presentations are similar, featured with typical facial features, short stature, intellectual disability, ectodermal abnormalities, congenital heart diseases, chest & skeletal deformity and delayed puberty. During past decades, molecular etiologies of RASopathies have been growingly discovered. The functional perturbations of the RAS-mitogen-activated protein kinase pathway are resulted from the mutation of more than 20 genes (PTPN11, SOS1, RAF1, SHOC2, BRAF, KRAS, NRAS, HRAS, MEK1, MEK2, CBL, SOS2, RIT, RRAS, RASA2, SPRY1, LZTR1, MAP3K8, MYST4, A2ML1, RRAS2). The PTPN11 (40–50%), SOS1 (10–20%), RAF1 (3–17%), and RIT1 (5–9%) mutations are common in NS patients. In this review, the constellation of overlapping clinical features of RASopathies will be described based on genotype as well as their differential diagnostic points and management.

Development of Vitiligo-Like Depigmentation after Treatment of Lentigo Maligna Melanoma with 5% Imiquimod Cream

A 69-year-old man presented with a black irregular patch on his left cheek. Skin biopsy revealed lentigo maligna melanoma in situ. He was treated via partial excision of the melanoma, followed by the application of 5% imiquimod cream every other night for 6 to 8 hours. The patient experienced severe local inflammation accompanied by burning, edema, and erythema, as well as oozing and crusting. The patient discontinued using the imiquimod cream after 15 applications because of the inflammation. Depigmentation was noted in the treated area 3 months after the initiation of treatment with imiquimod cream. Histological examination using Melan-A staining of the depigmented area revealed an absence of melanocytes, which is consistent with vitiligo. The depigmented lesions improved considerably after a 5-year follow-up, and there was no recurrence of melanoma.

Multiple Lentigines Arising in Sites of Resolving Psoriatic Plaques after Treatment with Ustekinumab

No abstract available.

Beneficial Effect of Low Fluence 1,064 nm Q-Switched Neodymium:Yttrium-Aluminum-Garnet Laser in the Treatment of Senile Lentigo

BACKGROUND: Low fluence 1,064 nm Q-switched (QS) Neodymium:Yttrium-Aluminum-Garnet (Nd:YAG) laser treatment, also known as laser toning, is widely used for pigmentary disorders. There has been no reliable evaluation of the effect of low fluence 1,064 nm QS Nd:YAG laser for senile lentigo. OBJECTIVE: To investigate the beneficial effect of low fluence 1,064 nm QS Nd:YAG laser in the treatment of senile lentigo on the face. METHODS: A retrospective review was conducted on patients treated only with repetitive low fluence 1,064 nm QS Nd:YAG laser. Among them, 12 patients with multiple senile lentigines before treatment were included. All side effects were recorded to assess the safety of the modality. RESULTS: Mean age was 56.1±7.8 years old and male-to-female ratio was 1:11. Mean treatment fluence was 1.62±0.16 J/cm² and mean total treatment session was 8.8±2.6. Mean interval period between each session was 28.0±11.4 days and mean treatment session to reach marked and near total improvement was 8.7±2.8. At the final visit, seven of 12 (58.3%) patients reached marked and near total improvement, and three of 12 (25.0%) reached moderate improvement. No side effects occurred. CONCLUSION: Repetitive low fluence 1,064 nm QS Nd:YAG laser treatment may be an effective and safe optional modality for senile lentigo.

Melanoma lentiginoso acral en una paciente adulta / Acral lentiginous melanoma in an adult patient

Se presenta el caso clínico de una paciente ecuatoriana de 58 años, blanca, con antecedentes de hernias discales en regiones cervical y lumbar, quien hace 2 años asistió a la Consulta de Dermatología por presentar cambio de coloración en la uña del tercer dedo de la mano derecha, síntomas que se correspondían con un lentigo simple. En esta ocasión acude con destrucción de la lámina ungueal y aumento de la coloración que se extiende a todo el pulpejo del dedo, por lo cual se le realizó otra biopsia y se confirmó el diagnóstico histológico de melanoma lentiginoso acral (in situ).

The case report of a 58 years white patient is presented with a history of disk herniation in cervical and lumbar regions, who 2 years ago attended the Dermatology Service due to a color change in the fingernail of the third finger of her right hand, symptoms that belonged to a lentigo simplex. In this occasion she presented destruction of the ungueal bed and increase of color which covers the whole fingertip, so another biopsy was carried out and the histological diagnosis of acral lentiginous melanoma (in situ) was confirmed.

Skin Pigmentation and Pigmentary Disorders: Focus on Epidermal/Dermal Cross-Talk

Variation in human skin and hair color is the most notable aspect of human variability and several studies in evolution, genetics and developmental biology contributed to explain the mechanisms underlying human skin pigmentation, which is responsible for differences in skin color across the world's populations. Despite skin pigmentation is primarily related to melanocytes functionality, the surrounding keratinocytes and extracellular matrix proteins and fibroblasts in the underlying dermal compartment actively contribute to cutaneous homeostasis. Many autocrine/paracrine secreted factors and cell adhesion mechanisms involving both epidermal and dermal constituents determine constitutive skin pigmentation and, whenever deregulated, the occurrence of pigmentary disorders. In particular, an increased expression of such mediators and their specific receptors frequently lead to hyperpigmentary conditions, such as in melasma and in solar lentigo, whereas a defect in their expression/release is related to hypopigmented disorders, as seen in vitiligo. All these interactions underline the relevant role of pigmentation on human evolution and biology.

Retrospective Review of 19 Patients with Lentigo Maligna Melanoma / 대한피부과학회지

BACKGROUND: Lentigo maligna melanoma (LMM) is a subtype of melanoma that typically develops on sun-damaged skin. LMM is estimated to comprise 4~15% of melanomas, but the prevalence is known to be relatively lower in the Korean population than in the Caucasian population. OBJECTIVE: To review the clinico-pathologic features and treatment outcomes of Korean patients with LMM. METHODS: Nineteen patients diagnosed with LMM during 2003~2015, in the Yonsei University Health System, were included in this study. The age and sex of the patients, lesion location, thickness (Breslow), stage, treatment methods, BRAF, NRAS, and KIT mutation status, and survival rates were analyzed. RESULTS: Among the 19 Korean patients, 11 were male and 8 were female. The median age was 59.2 years. The most common site was the cheek (47.4%), followed by the scalp, eyelid, nose, forehead, lip, and neck. At the time of diagnosis, 13 patients were in localized stages (5 patients, stage 0; 3 patients, stage I; and 5 patients, stage II) and 6 patients were in advanced stages (3 patients, stage III; and 3 patients, stage IV). Patients in the localized stages showed better overall survival (OS) than those in the advanced stages (p=0.012). Nine patients were treated with a wide excision, and 6 using Mohs micrographic surgery. Three patients received high-dose interferon-α therapy; 6, chemotherapy; and 4, radiotherapy. Two patients in stage 0 were treated with topical ingenol mebutate. Two patients had BRAF V600E mutation; 1, NRAS G12R mutation; and 1, KIT mutation. Median OS of the patients was 40.8 months. CONCLUSION: Our analysis provides additional information about clinical characteristics, treatment, and prognosis of LMM in Korean patients.

Síndromes lentiginosos familiares / Family lentiginous syndromes

Los síndromes lentiginosos familiares (SLF)involucran un amplio espectro fenotípico, que abarcadesde una predisposiciónhereditaria a desarrollar lentigos sinenfermedad sistémica hasta un riesgo incrementado en la formación de hamartomas, hiperplasias y otras neoplasias.El prototipo de SLF es el síndrome de Peutz-Jeghers, pero también se incluyen dentro de este grupo de patologías el complejo de Carney, el síndrome LEOPARD, el síndrome de Bannayan-Riley-Ruvalcaba, la enfermedad de Cowden, el síndrome de Laugier-Hunziker, la disección arterial con lentiginosis y las lentiginosis benignas (lentiginosis unilateral parcial y centrofacial).La presencia de lentigos es uno de los hallazgos semiológicos más prominentes en estos cuadros y probablemente, más que una característica clínica asociada, sea el reflejo de la convergencia entre vías de señalización de importancia crucial para la embriogénesis, la diferenciación de la cresta neural, el crecimiento de los órganos diana y el funcionamiento de una amplia gama de tejidos.En el presente trabajo se realiza una descripción detallada de cada uno de los SLF, incluyendo el mecanismo molecular involucrado, las manifestaciones clínicas, la metodología diagnóstica, el seguimiento y el tratamiento.

Familial lentiginosis syndromes involve a broad phenotypic spectrum that includesfrom hereditary predisposition to presentlentigines without systemic disease to the increased risk of hamartomas, hyperplasia and other malignancies development.The prototype is Peutz-Jeghers syndrome, but Carney complex, LEOPARD syndrome, Bannayan-Riley-Ruvalcaba syndrome, Cowden's disease, Laugier-Hunziker syndrome, arterial dissection with lentigines and benign lentiginosis (partial and unilateral centrofaciallentigines) are also included in this group.The presence of lentigines is the most relevant finding and probably more than a clinical feature associated represents a reflection of the convergence of crucial signaling pathways that are important to embryogenesis, differentiation of the neural crest, target organs growth and funcional of a wide range of tissues.In this paper we perform a detailed description of these syndromes, including the molecular mechanisms involved, clinical manifestationsdiagnostic procedures, monitoring, and treatment.

Cirugía micrográfica de Mohs y técnica del espagueti para melanoma in situ de cabeza y cuello / Melanoma in situ of the head and neck treated with Mohs surgeryor “spaghetti technique”

Antecedentes: el lentigo maligno (LM) es un subtipo de melanoma in situ (MMis) que ocurre en áreas fotoexpuestas de cabeza y cuello (CC) de pacientes añosos. El margen quirúrgico necesario para su resección no fue confirmado por estudios controlados-randomizados.Existen distintas técnicas para el estudio histológico exhaustivo de márgenes: cirugía de Mohs (CMM), slow Mohs (SM), staged excision (SE) y técnica del espagueti (TE). Objetivo: describir las características epidemiológicas, clínicas, tratamiento y evolución de pacientes con MMis-CC tratados por nuestro grupo con CMM y TE. Diseño: estudio descriptivo, observacional y retrospectivo. Métodos: se analizó edad, sexo, histología, tratamiento y evolución de 103 MMis-CC en 102 pacientes, tratados entre 6/1996 y 6/2014. Resultados: edad promedio: 66 años. Mujeres: 54,4%. Anatomía patológica: LM: 63 y MMis: 40. Tratamiento previo: 25,2%. En 36 casos se empleó CMM (los primeros 20 en tejidos frescos y desde diciembre de 2009 en parafina (SM)). Desde mayo de 2011 (67 casos) se empleó TE. En el 86,4% fue necesaria 1 capa de Mohs, en 10 pacientes: 2 capas, en 3: 3 y en 1: 4. Se conoce la evolución de 101/102 pacientes, media de seguimiento:27,7 meses. A un paciente con lesión muy extensa que no completó la cirugía se lo excluyó del análisis de recidivas. Observamos 1 (0,99%) recidiva. Tasa de control de la enfermedad:99%. Conclusiones: las técnicas con control exhaustivo de márgenes para el tratamiento del MMis-CC son altamente eficaces, permiten preservar tejido sano en zonas de gran importanciafuncional y estética.

Background: lentigomaligna (LM) is a subtype of in situ melanoma (isMM)deberia serMIS. It usually occurs in sun-exposed areas of the head and neck (HN) of elderly patients.Safe surgical margins after removal were not confirmed by randomized and controlledstudies. There are different techniques for histological study of margins: Mohs surgery(MS), slow Mohs (SM), "staged excision" (SE) and spaghetti technique (ST).Objective: to describe epidemiological, clinical, treatment and outcome of patients withisMM-HN treated by our group using MS and ST.Design: descriptive, observational and retrospective study.Methods: we analyzed age, sex, histology, treatment and outcome of 103 isMM-HN in102 patients treated between 6/96 and 6/14.Results: mean age: 66 years. Women: 54.4%. Pathology: LM: 63 and isMM: 40. Previoustreatment:25.2%. MS in 36 cases (the first 20 with fresh tissue technique, and since12/09 with paraffin sections (SM)). Since 5/11 (67 cases) ST was preferred. In 86.4%, 1layer was necessary, 2 layers: 10, 3 layers: 3 and 4 layers: 1 patients. Known evolution:99% (102/103) with a median follow up of 27.7 months. A patient with an extensivelesion did not complete the surgery, and was excluded from the recurrence analysis. Weobserved 1 (0.99%) recurrence. Control of disease rate: 99%.Conclusions: the detailed margin-control techniques for the treatment of LM are highlyeffective, enabling to preserve healthy tissue at high functional and aesthetic importanceareas.

Possible Involvement of Keratinocyte Growth Factor in the Persistence of Hyperpigmentation in both Human Facial Solar Lentigines and Melasma

No abstract available.

Objective Evaluation of the Effect of Q-Switched Nd:YAG (532 nm) Laser on Solar Lentigo by Using a Colorimeter

No abstract available.

Lentigo benigno facial: manejo quirúrgico a propósito de un caso / Benígn facíallentígo: surgícal management a purpose case

El lentigo benigno es un trastorno de la pigmentación de la piel, que se caracteriza por la presencia de manchas pigmentadas en la piel, de distintos tamaños y cuyo número varía de unas cuantas lesiones a varias. Se localizan preferentemente en zonas de exposición solar, su color generalmente es marrón claro, de bordes regulares y simétricos. Se presenta el caso de un paciente de 71 años, procedente de Chimbote, quien es enviado para evaluación y tratamiento con el diagnóstico presuntivo de melanoma. Presenta mancha de color marrón en mejilla izquierda, en algunas áreas con tonalidades más oscuras, asimétrico y de borde irregular. Se presenta este caso, para mostrar el manejo quirúrgico efectuado, con un buen resultado estético.

Benign lentigo is a pigmentation disorder of the skin, characterized by the presence of pigmented spots on the skin, of different sizes and the number of which varies from a few lesions to several. Are preferentially located in areas of sun exposure, its color is usually light brown, regular and symmetrical edges. The case of a 71 year old from Chimbote, who is sent for evaluation and treatment with the presumptive diagnosis of melanoma, is presented. He presents a brown spot on left cheek, in some areas with darker, asymmetric and irregular edge tones. This case is presented to show surgical management performed, with a good cosmetic result.

Insight into evolution of a giant congenital nevomelanocytic nevus over 14 years.

Giant congenital nevomelanocytic nevus (GCNN) is a rare variant of congenital melanocytic nevus measuring >20 cm in size that often has a garment-like distribution. Regular follow up is recommended because of a risk of melanoma transformation of 4.6%. We report a 14-year-old boy with gradual regression of giant congenital melanocytic nevus over the left upper limb, chest, back and axilla, whom we have followed-up since birth. At birth, a hyperpigmented jet-black patch without hair was present over the left side of torso and upper limb including palms and nails. Follow up at the ages of 1, 5, 11 and 14 years showed progressive spontaneous regression of the nevus resulting in shiny atrophic skin, diffuse hypopigmentation, lentigo-like macules, nodules and arthrogryphosis of affected areas. Histopathology of the lesions on follow-up revealed absence of pigmented nevus cells in the regressing areas and thickened sclerotic collagen bundles.