ABSTRACT
Introducción: Las metástasis en tránsito en pacientes con melanoma cutáneo son un tipo especial de metástasis que se han asociado a diferentes factores pronósticos adversos. Recientemente se ha sugerido que la técnica de la biopsia selectiva del ganglio centinela (BSGC) podría aumentar la incidencia de metástasis en tránsito, por lo que en este trabajo nos proponemos analizar dicha relación y los factores de riesgo de aparición de dichas metástasis. Material y métodos: Se analizó de forma prospectiva una cohorte de 404 pacientes con melanoma cutáneo de la Unidad de Melanoma del Hospital San Cecilio (Granada). Para el análisis estadístico se utilizó el programa estadístico SPSS 15.0 y Epidat 3.1, usando el test Chi-cuadrado y el test exacto de Fisher. Resultados: De los 93 (23%) pacientes que presentaron recidiva en algún momento de la evolución, 28 (6,9%) fueron metástasis en tránsito. La aparición de metástasis en tránsito se relacionó de forma positiva con la edad superior a 50 años, mayor espesor de Breslow y nivel de Clark, presencia de ulceración, positividad de la BSGC, y presencia de otro tipo de recidiva (local, ganglionar o a distancia). No hubo relación entre el tratamiento quirúrgico recibido o la realización de la BSGC y la presencia de metástasis en tránsito. Discusión: Los factores de riesgo para la aparición de recidivas en general y de metástasis en tránsito en particular son los mismos, y coinciden con otros datos de mal pronóstico. Esto, unido a que las metástasis en tránsito son mucho más frecuentes en el grupo con BSGC positiva y que no se relacionan con la técnica en sí, nos hace pensar que la aparición de este tipo de metástasis se debe a características adversas de la biología tumoral del melanocito, más que a una influencia de la técnica quirúrgica (AU)
Background: In-transit metastases have been associated with the presence of various negative prognostic factors in patients with cutaneous melanoma. It has recently been suggested that sentinel lymph node biopsy (SLNB) may lead to an increase in the incidence of this particular type of metastasis. In this study, we analyzed risk factors for the appearance of in-transit metastasis and its potential association with the use of SLNB. Material and methods: A prospective study was undertaken in a cohort of 404 patients with cutaneous melanoma seen in the melanoma unit of Hospital San Cecilio in Granada, Spain. Statistical analysis was performed with SPSS 15.0 and Epidat 3.1 using the ÷2 and Fisher exact tests. Results: Out of 93 (23%) patients with recurrence at any time, 28 (6.9%) had in-transit metastases. The occurrence of in-transit metastasis was associated with age greater than 50 years, greater Breslow depth and Clark level, the presence of ulceration, positive SLNB, and the presence of other types of recurrence (local recurrence, lymph node metastasis, or distant metastasis). There was no relationship between surgical treatment or performing SLNB and the presence of in-transit metastasis. Conclusions: The risk factors for in-transit metastasis are the same as those for any type of recurrence and coincide with factors linked to poor prognosis. Given that in-transit metastases are much more common in patients with positive SLNB, while the technique itself is not linked to their occurrence, these findings suggest that the appearance of in-transit metastasis is linked to biological characteristics of the tumor cells rather than an influence of the surgical technique(AU)
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Risk Factors , Melanoma/complications , Neoplasm Metastasis/physiopathology , Prognosis , Prospective Studies , 28599 , Sentinel Lymph Node Biopsy/methodsABSTRACT
BACKGROUND: In-transit metastases have been associated with the presence of various negative prognostic factors in patients with cutaneous melanoma. It has recently been suggested that sentinel lymph node biopsy (SLNB) may lead to an increase in the incidence of this particular type of metastasis. In this study, we analyzed risk factors for the appearance of in-transit metastasis and its potential association with the use of SLNB. MATERIAL AND METHODS: A prospective study was undertaken in a cohort of 404 patients with cutaneous melanoma seen in the melanoma unit of Hospital San Cecilio in Granada, Spain. Statistical analysis was performed with SPSS 15.0 and Epidat 3.1 using the χ(2) and Fisher exact tests. RESULTS: Out of 93 (23%) patients with recurrence at any time, 28 (6.9%) had in-transit metastases. The occurrence of in-transit metastasis was associated with age greater than 50 years, greater Breslow depth and Clark level, the presence of ulceration, positive SLNB, and the presence of other types of recurrence (local recurrence, lymph node metastasis, or distant metastasis). There was no relationship between surgical treatment or performing SLNB and the presence of in-transit metastasis. CONCLUSIONS: The risk factors for in-transit metastasis are the same as those for any type of recurrence and coincide with factors linked to poor prognosis. Given that in-transit metastases are much more common in patients with positive SLNB, while the technique itself is not linked to their occurrence, these findings suggest that the appearance of in-transit metastasis is linked to biological characteristics of the tumor cells rather than an influence of the surgical technique.
Subject(s)
Lymphatic Metastasis/pathology , Melanoma/secondary , Neoplasm Invasiveness/physiopathology , Sentinel Lymph Node Biopsy/adverse effects , Skin Neoplasms/secondary , Adult , Aged , Cell Movement , Cicatrix/pathology , Disease Susceptibility , Female , Humans , Incidence , Lymphatic Metastasis/diagnosis , Male , Melanoma/epidemiology , Melanoma/pathology , Melanoma/surgery , Middle Aged , Neoplasm Recurrence, Local/epidemiology , Neoplasm Seeding , Neoplastic Stem Cells/pathology , Organ Specificity , Prognosis , Prospective Studies , Risk Factors , Skin Neoplasms/pathology , Skin Neoplasms/surgery , Skin Ulcer/etiology , Spain/epidemiology , Subcutaneous Tissue/pathologyABSTRACT
Introducción: Los dermatólogos somos demandados a diario, en nuestro centro de trabajo, por pacientes sin cita reglada (acompañantes de pacientes, médicos de otras especialidades, trabajadores del centro, etc.). Objetivos: Descripción de los pacientes demandantes, los motivos de consulta, la gravedad de la patología consultada, la actitud diagnóstico-terapéutica y asistencial de los profesionales demandados. Resultados: El paciente modelo sería una mujer enfermera de mediana edad que consulta por primera vez por una lesión tumoral melanocítica benigna. En general el dermatólogo tomará una actitud terapéutica empírica o informadora y considera que la atención prestada es similar a un paciente con cita reglada. Conclusiones: Las consultas no regladas, aunque suelen ser por patología banal, suponen una carga asistencial en la práctica diaria (AU)
Background: Dermatologists are regularly consulted in their place of work by patients without an official appointment (individuals accompanying other patients, doctors from other specialties, hospital workers, etc). Objectives: To describe the characteristics of consulting patients, reasons for consultation, severity of complaint, diagnostic and therapeutic approach taken, and level of care provided by the consulted professionals. Results: The typical patient would be a middle-aged female nurse consulting for the first time for a benign melanocytic lesion. In general, the dermatologist will take an empirical or informative therapeutic approach and consider the care provided to be similar to that offered to patients with an official appointment. Conclusions: Unofficial appointments, although commonly for trivial complaints, represent an additional workload in daily clinical practice (AU)
Subject(s)
Humans , Referral and Consultation/statistics & numerical data , Skin Diseases/diagnosis , Appointments and Schedules , Workload/statistics & numerical data , Medical Chaperones/statistics & numerical data , Health Services AccessibilitySubject(s)
Humans , Male , Female , Epidermis/pathology , Melanoma/pathology , Melanoma/diagnosis , Ulcer , PrognosisABSTRACT
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Subject(s)
Humans , Female , Adult , Elastic Tissue/physiopathology , Dermis/physiopathology , Skin Diseases, Papulosquamous/diagnosis , Diagnosis, DifferentialSubject(s)
Epidermis/pathology , Melanoma/pathology , Skin Neoplasms/pathology , Abdomen , Arm , Humans , Male , Middle Aged , PrognosisABSTRACT
BACKGROUND: Dermatologists are regularly consulted in their place of work by patients without an official appointment (individuals accompanying other patients, doctors from other specialties, hospital workers, etc). OBJECTIVES: To describe the characteristics of consulting patients, reasons for consultation, severity of complaint, diagnostic and therapeutic approach taken, and level of care provided by the consulted professionals. RESULTS: The typical patient would be a middle-aged female nurse consulting for the first time for a benign melanocytic lesion. In general, the dermatologist will take an empirical or informative therapeutic approach and consider the care provided to be similar to that offered to patients with an official appointment. CONCLUSIONS: Unofficial appointments, although commonly for trivial complaints, represent an additional workload in daily clinical practice.
Subject(s)
Dermatology/statistics & numerical data , Hospitals, Special/statistics & numerical data , Patient Acceptance of Health Care/statistics & numerical data , Adolescent , Adult , Aged , Aged, 80 and over , Appointments and Schedules , Attitude of Health Personnel , Child , Child, Preschool , Family , Female , Friends , Humans , Infant , Male , Middle Aged , Nevus, Pigmented/diagnosis , Personnel, Hospital , Skin Diseases/diagnosis , Skin Diseases/psychology , Skin Diseases/therapy , Young AdultSubject(s)
Foot Dermatoses/complications , Pain Management , Pain/etiology , Warts/complications , Humans , ShoesABSTRACT
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Subject(s)
Humans , Warts/complications , Foot Dermatoses , Orthotic Devices , Pain/therapyABSTRACT
Introducción. El tratamiento quirúrgico del melanoma cutáneo con unos márgenes adecuados al espesor del tumor va a hacer que, en ciertas localizaciones, sea frecuente tener que cubrir el defecto quirúrgico mediante injertos de piel total o parcial. Cuando haya que realizar biopsia selectiva del ganglio centinela (BSGC) con la técnica clásica el paciente tendrá tres heridas, una en la zona del primario cubierta por el injerto, otra en la axila o la ingle, por donde hemos hecho la BSGC, y otra, casi siempre la más molesta, en la zona dadora del injerto. Material y métodos. Presentamos 10 pacientes tratados en nuestro Servicio en los que se realizó una técnica alternativa que redujo el número resultante de heridas. Para ello se obtuvo el injerto de piel total de la zona de la axila o de la ingle que recubría el ganglio centinela. Resultados. La BSGC sólo fue positiva en un caso, al que se realizó linfadenectomía inguinal. Sólo se produjo una complicación postoperatoria leve en un paciente, con una pérdida parcial del injerto y la estancia hospitalaria media fue de 6,2 días. Después de un seguimiento variable entre 11 y 56 meses, no se han detectado casos de recidiva local ni de metástasis. Conclusiones. La técnica que presentamos tiene la ventaja de que simplifica aún más el tratamiento quirúrgico del melanoma, reduce las dificultades en la disección del ganglio centinela al permitirnos una vía de abordaje más amplia y, además, disminuye la morbilidad asociada a la intervención (AU)
Background. Surgical treatment of skin melanoma with skin margins in accordance with tumor thickness often necessitates covering the surgical defect with full or partial thickness skin grafts. When selective sentinel node biopsy is indicated, traditional procedures require 3 incisions: 1 in the region of the primary tumor covered by the graft, 1 in the axilla or groin corresponding to the site of the selective sentinel lymphnode biopsy, and 1almost always the most uncomfortablein the donor site for the skin graft. Patients and methods. We present 10 patients attended in our department who underwent an alternative technique to reduce the number of wounds. A full thickness skin graft was obtained from the axillary or inguinal region covering the sentinel node. Results. Sentinel node biopsy was positive in 1 patient, who subsequently underwent inguinal lymphadenectomy. Only 1 mild postoperative complication was reported in a patient with partial graft loss. The mean hospital stay was 6.2 days. After follow-up ranging from 11 to 56 months, no local recurrences or metastases had been detected. Conclusion. The technique we present has the advantage of further simplifying surgical treatment for melanoma. It reduces the problems associated with sentinel node dissection by affording a wider access and is also associated with less morbidity (AU)
Subject(s)
Humans , Male , Female , Melanoma/surgery , Skin Transplantation/methods , Skin Neoplasms/surgery , Plastic Surgery Procedures/methods , Sentinel Lymph Node BiopsyABSTRACT
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Subject(s)
Humans , Female , Adult , Tinea Pedis/diagnosis , Pigmentation Disorders/diagnosis , Diagnosis, Differential , Exophiala/isolation & purificationABSTRACT
El granuloma de Majocchi es una dermatofitosis bien conocida, aunque infrecuente, generalmente causada por especies de Trichophyton. Presentamosel caso de un varón de 56 años que consultó por una placa en antebrazo de tres años de evolución, asintomática, de crecimiento progresivo. Eneste tiempo le habían realizado dos biopsias sin llegar a un diagnóstico y había sido tratado con clobetasol tópico sin ninguna mejoría. Con la sospechade una tiña incógnito se le practicó una nueva biopsia, se tomaron muestras para cultivo y se inició tratamiento con griseofulvina oral con resolucióncompleta del cuadro a las seis semanas. El diagnóstico histológico fue de granuloma de Majocchi y el cultivo demostró Trichophyton verrucosum.Aunque la mayoría de los casos de granuloma de Majocchi se han descrito en piernas de mujeres de edad media con antecedente de algún traumalocal, cada vez se están comunicando más casos de presentación atípica, como el nuestro, y es muy frecuente verlos enmascarados como una tiñaincógnita por la aplicación previa de corticoides (AU)
Majocchi´s granuloma is a rare but well known dermatophytosis, usually caused by Trichophyton species. We report a case of a 56-year-old man whohad a 3-year-evolution plaque in his forearm, asympthomatic, which had been growing up progressively. During this time he had been treated withtopical clobetasol, with no resolution, and two skin biopsies were performed, with no histopathological diagnosis. With clinical diagnosis of tineaincognito, local cultures and a new skin biopsy were performed, and we started treatment with oral griseofulvine, with complete remission of the diseasein 6 weeks time. Majocchi´s granuloma was the histopathologic diagnosis and cultures proved the infection with Trichophyton verrucosum.Althoug most cases of Majocchi´s granuloma have been reported in lower legs of young women with local trauma such us depilation, nowadays moreand more cases are being reported with unusual clinical presentations, and it is more common to see such cases showing as a tinea incognito becauseof previous use of topical corticosteroids (AU)
Subject(s)
Humans , Male , Middle Aged , Dermatomycoses/diagnosis , Trichophyton/isolation & purification , Granuloma/diagnosis , Tinea/diagnosis , Diagnosis, DifferentialSubject(s)
Analgesics, Opioid/adverse effects , Pentazocine/adverse effects , Skin Ulcer/chemically induced , Humans , Male , Middle Aged , ThighABSTRACT
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Subject(s)
Humans , Child, Preschool , Child , Adolescent , Young Adult , Melanocytes/pathology , Melanoma/epidemiology , Nevus, Pigmented/congenital , Skin Neoplasms/epidemiology , Cell Transformation, Neoplastic , Disease Progression , Nevus, Pigmented/pathologyABSTRACT
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