Fibroxantoma atípico: caso clínico / Scalp atypical fibroxanthoma: report of one case

Atypical Fibroxanthoma is an unusual dermal mesenchymal tumor. It especially affects older adults and occurs in areas of sun exposure. We report a 75 years old male with a history of sun exposure without using a hat presenting with a scalp nodule. An incisional biopsy showed an atypical fibroxantoma. In a new surgical procedure, the tumor was completely excised. The tumor relapsed in two occasions after subsequent excisions and the patient was treated with adjuvant radiotherapy avoiding new relapses.

Complicaciones de la radioterapia: fenómeno de Lhermitte gatillado por calor: caso clínico / Complications of radiotherapy: Lhermitte phenomenon triggered by heat: report of one case

Lhermitte phenomenon is a neurological symptom described as a sensation of electric shock that radiates from the back towards the extremities, which appears when a patient flexes the neck. A transient myelopathy as a late complication of radiotherapy is associated with this symptom. It appears two to four months after treatment and disappears spontaneously. We report a 45 years old female with a neck malignant melanoma treated with surgery and adjuvant radiotherapy. She experienced the Lhermitte phenomenon that was triggered by heat. This phenomenon must be differentiated from the Uhthoff phenomenon.

Sarcoma de Kaposi: variedades clínicas y resultados del tratamiento local con radioterapia / Local radiation treatment of Kaposi's sarcoma: clinical varieties and treatment outcomes

Background: Kaposi's sarcoma (KS) is a rare tumor that affects mainly immunodeficient and elderly patients. Aim: To describe the features and outcomes of a cohort of patients with different types of KS treated locally with radiotherapy (RT). Patients and Methods: Retrospective review of patients with KS referred to our radiation oncology center for local treatment of symptomatic lesions that did not respond to high activity anti-retroviral therapy or chemotherapy. Results: Between January 1995 and December 2016, 20 patients with a median age of 40 years (18 males) with KS were assessed and treated with RT due to symptomatic lesions. The most common KS type was epidemic in 15 patients, followed by the classic type in three and the iatrogenic variety in two. In patients with non-epidemic varieties, SK was exclusively cutaneous, while visceral involvement was present in 46% of patients with epidemic SK. Complete response was observed in 95% of cases. Skin toxicity caused by RT was mild in all cases. Conclusions: RT may be considered as a reasonable local treatment choice in classic, iatrogenic and epidemic varieties of KS.

Angiosarcoma cutáneo en la región nasal tratado con radioterapia: reporte de caso / Cutaneous Angiosarcoma Nasal Region treated with Radiation Therapy: Case Report

El angiosarcoma cutáneo es un tumor poco frecuente con tendencia a localizarse en la cabeza y el cuello, en especial en el cuero cabelludo y la cara. Es considerado un tumor de rápido crecimiento y frecuentemente hace metástasis a distancia. Su tratamiento no está claramente definido y es basado en estudios retrospectivos y reportes de caso. Al parecer, la mejor opción de manejo es la cirugía con resección local amplia y, en lo posible, con bordes negativos; posteriormente, radioterapia adyuvante, debido a la alta tasa de recaída que presentan estos tumores. Se presenta el caso de un paciente de 91 años quien recibió manejo exclusivo con radioterapia hipofraccionada, quien presentó respuesta completa a los tres meses de finalizar y permaneció libre de enfermedad hasta la fecha de este reporte, ló meses después de la radioterapia.

Cutaneous angiosarcoma is a rare tumor with a tendency to be located in the head and neck especiallv on the scalp and face. It is considered a rapidly growing tumor and often causes distant metastases. The treatment of this tumor is not clearly defined and is based on retrospective studies and case reports, still seems the best option handling surgery with wide local excisión and possibly with negative margins and subsequently adjuvant radiotherapy due to the high rate relapse presented by these tumors. We report the case of a patient of 91 years who received exclusive management with radiotherapy hypofractionated presenting complete response at 3 months after completion and remaining free of disease until the date of this report, 16 months after radiotherapy.

Clinical exuberance of classic Kaposi's sarcoma and response to radiotherapy

Abstract: Kaposi's sarcoma (KS) is a multicentric vascular neoplasm, with cutaneous and extracutaneous involvement. Different clinical and epidemiological variants have been identified. The classic form is manifested mainly in elderly men with indolent and long-term evolution, with lesions localized primarily in the lower extremities. We present two cases of classic Kaposi's sarcoma (CKS) in two female patients with extensive, exuberant skin involvement and rapid evolution, with good response to radiotherapy.

Porocarcinoma ecrino: reporte de un caso / Eccrine porocarcinoma: a case report

Los tumores anexiales de la piel representan un grupo heterogéneo de entidades de baja frecuencia de presentación. Su origen es controvertido, quizás a partir de células madres pluripotenciales, aceptándose principalmente dos líneas embriológicas: pilosebáceo-apócrina y ecrina. Se los clasifica en cuatro grupos principales: tumores del folículo piloso, tumores sebáceos, tumores apócrinos y tumores ecrinos. Su distribución anatómica refleja áreas con mayor densidad de anexos cutáneos, presentándose en forma única o múltiple.

Skin adnexal tumors are represented as a heterogeneous group of entities of low frequency range. Its origin is controversial, perhaps from pluripotent stem cells, mainly from two embryological lines: pilosebaceous-apocrine and eccrine. They are classified as four main groups: tumors of the hair follicle, sebaceous tumors, apocrine tumors and eccrine tumors. Their anatomic distribution reflects areas with the highest density of cutaneous adnexal, arising in either single or multiple forms.

Primary cutaneous centrofollicular lymphoma with a good response to radiotherapy / Linfoma centrofolicular cutaneo primario com boa resposta a radioterapia

Primary cutaneous lymphomas have different clinical behavior and prognosis than systemic lymphomas of similar histological subtype. About 30% of non-Hodgkin lymphomas involve extranodal tissues, the skin being the second most affected body organ after the gastrointestinal tract (approximately 18%). According to the EORTC (European Organization for Research and Treatment of Cancer) classification, the lymphoma centrofollicular is indolent, since the lesions increase in size slowly over the years and spread to extracutaneous sites is uncommon. Based on this, radiotherapy has been considered the treatment of choice by many studies. We present the case of a patient who had cutaneous centrofollicular scalp lymphoma for 1 year and showed good response to radiotherapy.

Os linfomas cutâneos primários têm comportamento clínico e prognóstico diferente dos linfomas sistêmicos de subtipo histológico semelhante. Cerca de 30% dos linfomas não-Hodgkin acometem tecidos extranodais, sendo a pele o segundo órgão mais envolvido após o trato gastrointestinal (aproximadamente 18%). De acordo com a classificação EORTC (European Organization for Research and Treatment of Cancer), o linfoma centrofolicular cutâneo é indolente, uma vez que as lesões aumentam de tamanho lentamente ao longo dos anos e a disseminação para sitios extracutâneos é incomum. Com base nisso, a radioterapia tem sido apontada como o tratamento de primeira escolha por muitos estudos. Apresentamos um caso de paciente com linfoma cutâneo centrofolicular no couro cabeludo há 1 ano e que apresentou boa resposta à radioterapia.

Micose fungoide: relato de caso tratado com radioterapia / Mycosis fungoides: case report treated with radiotherapy

Micose fungoide é um tipo de linfoma não Hodgkin de células T raro que acomete primariamente a pele. Caracteriza-se pela presença de placas eritematosas que evoluem para lesões ulceradas, tumores em toda a pele ou ainda infiltração de medula óssea em estágios avançados. Como opção de tratamento para os casos iniciais, tem-se quimioterapia e corticoterapia tópica, fototerapia e radioterapia. Este estudo relata o caso de um doente com múltiplas lesões tumorais na pele já biopsiadas com diagnóstico de micose fungoide. O paciente foi refratário ao tratamento com quimioterapia tópica e fototerapia, sendo então indicada irradiação total da pele com elétrons.

Mycosis fungoides is a rare type of non-Hodgkin's lymphoma of T cells that primarily affects the skin. It is characterized by the presence of erythematous plaques that evolve into ulcerated lesions, tumors throughout the skin or even bone marrow infiltration in advanced stages. Chemotherapy and topical steroids, phototherapy and radiotherapy are treatment options for early cases. This study reports the case of patient with multiple tumor lesions in the skin already biopsied with diagnosis of mycosis fungoides. The patient was refractory to both treatments with topical chemotherapy and phototherapy. It was then indicated total skin irradiation with electrons.

Neoplasia maligna en cicatriz de quemadura: úlcera de Marjolin: informe de dos casos y revisión de la literatura / Malignant neoplasm in burn scar: Marjolin's ulcer: report of two cases and review of the literature

BACKGROUND: Marjolin's ulcer forms part of a group of neoplasms that originate in a burn scar, a phenomenon associated with superficial tissue trauma. The frequency of Marjolin's ulcer is low and represents between 2 and 5% of all squamous cell carcinomas of the skin. This condition is found three times more frequently in men than in women and is thought to be more aggressive than conventional squamous cell carcinoma of the skin. CLINICAL CASES: We present two cases of squamous cell carcinoma that originated on a burn scar. 41 year old woman with gasoline burn on the left foot, 3 months old, in whom an exofitic ulcerated lesion on the right calcaneum region has evolved since she was 32 years old. Left transtibial amputation was decided. Another woman who started its suffering 9 years after a thorax burn with a progressive fungus lesion on the scar area. For its size and as it was a high degree neoplasia, surgical resection and radiotherapy to the zone of the primary with 50 Gy in 25 fractions was decided. CONCLUSIONS: Marjolin's ulcer usually occurs in old burn sites that were not skin grafted and were left to heal secondarily. Although it is believed that there is a latency period of 25-40 years after burn injury before the occurrence of malignancy, this may occur in a period as short as 3 months. Recurrence after radical surgery is 14.7%. Nonetheless, because of the aggressive behavior of this type of cancer, appropriate radical treatment allows an adequate control of the disease. Early grafting of the burn site can prevent the formation a malignant neoplasm. This condition should be suspected in a non-healing chronic ulcer on a burn scar.

Radioterapia en cáncer no melanoma / Radiotherapy for non-melanoma skin cancer

La radioterapia es la disciplina que emplea radiaciones ionizantes en terapia médica. Es una herramienta ampliamente utilizada en Oncología y también dentro de la patología oncológica cutánea. Se trata de un procedimiento agresivo y no exento de riesgos; sin embargo, sus beneficios se encuentran claramente demostrados desde hace décadas. En los últimos años han aparecido nuevas alternativas terapéuticas menos agresivas y, por lo tanto, muy atractivas. El objetivo de este trabajo es explicar los principios básicos de la radioterapia aplicada a la Dermatología, mostrar los tratamientos más representativos y sus resultados en cáncer de piel.

Radiotherapy is the discipline that uses ionizing radiation in medical therapy. It is widely used in both oncology and cutaneous oncological pathologies. While it is an aggressive procedure and not risk-free, its benefits have been clearly demonstrated for years.In recent years, new, less aggressive - and therefore more popular - therapies have appeared. We review the basic principals of radiotherapy applied to dermatology, present the most representative treatments, as well as its results on skin cancer.

Carcinoma de células de Merkel / Merkel cell carcinoma

El carcinoma de células de Merkel es una neoplasia maligna cutánea poco habitual que suele presentarse en individuos de raza blanca y edad avanzada habitualmente como una lesión nodular eritematosa de rápido crecimiento, localizada en la región de la cabeza y cuello, principalmente en Ia región periorbitaria. Su curso clínico es a menudo agresivo, con un elevado índice de recurrencias locales, diseminación linfática regional y metástasis sistémicas. El manejo de este tumor es controversial En la mayoría de los casos está indicada la resección quirúrgica seguida de radioterapia. No hay evidencia suficiente que la quimioterapia convencional adyuvante mejore la sobrevida y habitualmente se asocia con pobres resultados. La tasa de mortalidad relacionada con el tumor a 5 años puede alcanzar hasta un 65 por ciento.

Melanoma amelanótico: a propósito de un caso / Amelanotic melanoma: a purpose of a case

Melanoma es un cáncer de piel originado por los melanocitos, altamente agresivo y letal, con características macroscópica característica; se presenta caso de paciente masculino de 65 años que acude a consulta presentando masa inguinal izquierda de 3 meses de evolución, de crecimietno rápido, 10cm de diámetro, discretamente dolorosa al tacto, con antecedente de amputación supracondilia del miembro inferior ipsilateral hace 6 meses por ulcera varicosa e insuficiencia venosa crónica. Se practica biopsia incisional que reporta melanoma amelanótico una variante atípica de dificil diagnóstico. Actualmente recibiendo quimio y radioterapia.

Radioterapia no melanoma: há lugar? / Radiotherapy on melanoma: is there a place?

Melanoma é considerado tumor radio-resistente e o emprego de radioterapia no tratamento é controverso. Muitas questões sobre o seu uso ainda permanecem sem resposta e o objetivo desta revisão é apresentar as evidências mais recentes que suportam a utilização da radioterapia no tratamento da lesão primária, da metástase linfonodal e da metástase cerebral. Apesar da evidência radiobiológica demonstrar que o melanoma pode ser mais sensível à dose maior por fração, a experiência clínica não evidência superioridade dos regimes hipofracionados. Conclui o autor que, apesar das controvérsias, há situações na prática diária em que a radioterapia deve ser considerada: no paciente idoso, com lesão localizada na face e no couro cabeludo, sem condições para cirurgia. Após linfadenectomia quando o número de gânglios comprometidos for maior que dois, o tamanho exceder 4cm, houver invasão extra-capsular e as margens de ressecção dorem exíguas. Na metástase cerebral isolada ou múltipla, menor de 4cm, em número inferior a três, a radio-cirurgia é benéfica e oferece aumento na sobrevida quando comparada à radioterapia cerebral total. Regimes hipo-fracionados, com frações de 6Gy, duas vezes por semana devem ser preferenciais, pelo valor social baixo e índice de complicações relatado.

Actualización en el tratamiento del carcinoma basocelular / Update in the treatment of basocellular carcinoma

El carcinoma basocelular (CBC) es el tumor maligno más frecuente que el ser humano puede presentar en la vida. Es un tumor cutáneo de lento crecimiento, con malignidad local, que excepcionalmente da metástasis. Los factores predisponentes más importantes son la historia de fotoexposición prolongada y el fototipo cutáneo. Se distribuyen en un 99 por ciento en individuos de raza blanca, y las edades de presentación fluctúan entre los 40 y 79 años en el 95 por ciento de los casos, afectando a hombres y mujeres en similar proporción (1). El 85 por ciento de los CBC se presentan en cabeza y cuello, y de éstos, un 25 por ciento a 30 por ciento se manifiestan en la nariz (localización más frecuente). Los subtipos histológicos más frecuentes en orden decreciente son el Nodular, Superficial, Micronodular, Quístico, Adenoide, Infiltrante, Pigmentado, Morfeiforme, y Metaatípico (2). En la presente revisión se analizan los métodos terapéuticos existentes; algunos con una vasta experiencia y otros aún en investigación. Para ello se han separado en métodos Quirúrgicos y no Quirúrgicos (Tabla 1) (3, 4).