Incidence of complications in dermatological surgery of melanoma and non-melanoma skin cancer in patients with multiple comorbidity and/or antiplatelet-anticoagulants. Five year experience in our Hospital.

INTRODUCTION: Surgery is performed more frequently now at days, due to the increasing incidence of melanoma and no-melanoma skin cancer. There are different opinions among dermatologic surgeons between to continue or discontinue antithrombotic therapy prior to the procedure, which increases the risk of thromboembolic events. Prophylaxis with oral antibiotics in the postsurgical period is controversial. OBJECTIVE: To report the safety of surgery without suspending antithrombotic therapy and without oral antibiotic prophylaxis in dermatology surgery of patients with multiple comorbidities and polypharmacy. METHOD: We designed a retrospective study. We included a total of 655 patients; 96.6% had at least one comorbidity; 27.7% used aspirin and 4.3% some type of antithrombotic therapy. The most common type of skin tumor was basal cell carcinoma with 69.8. RESULTS: The complication rate was 4.2%; the most was wound dehiscence (1.1%), followed by partial necrosis (0.9%), infection (0.9%), reaction to foreign body (0.6%), complete necrosis (0.3%), bleeding (0.2%) and fistulae (0.2%). CONCLUSIONS: Based on the literature and our experience, dermatologic surgery is safe without suspending antithrombotic therapy or antibiotic prophylaxis in patients with multiple comorbidity.

INTRODUCCIÓN: La cirugía es uno de los procedimientos que se realizan con mayor frecuencia en dermatología debido a la mayor incidencia de cáncer de piel melanoma y no melanoma. Se han encontrado distintas posturas entre los cirujanos dermatólogos sobre continuar o suspender antiagregantes y anticoagulantes antes del procedimiento, lo cual incrementa el riesgo de eventos tromboembólicos, además de la preferencia de utilizar profilaxis antibiótica de forma posquirúrgica por algunos dermatólogos. OBJETIVO: Reportar nuestra experiencia en cuanto a la seguridad de la cirugía dermatológica sin la suspensión de anticoagulantes/antiagregantes y sin profilaxis antibiótica en pacientes con múltiple comorbilidad y polifarmacia. MÉTODO: Se revisaron 655 pacientes. El 96.6% tenían al menos otra enfermedad. El 27.7% utilizaba ácido acetilsalicílico y el 4.3% algún tipo de anticoagulante. El tipo de neoplasia más frecuente fue el carcinoma basocelular con 69.8%. RESULTADOS: La tasa total de complicaciones fue del 4.2%. La complicación más frecuente fue la dehiscencia de la herida (1.1%), seguida de la necrosis parcial (0.9%), la infección (0.9%), la reacción a cuerpo extraño (0.6%), la necrosis total (0.3%), la hemorragia (0.2%) y la fístula cutánea (0.2%). CONCLUSIONES: Basándonos en la literatura y nuestra experiencia, la cirugía dermatológica es segura sin suspender antitrombóticos ni indicar profilaxis antibiótica en pacientes con múltiple comorbilidad.

Dermoscopic patterns of filiform papillae of the tongue in patients with and without connective tissue autoimmune diseases.

BACKGROUND: Connective tissue autoimmune diseases (CTADs) constitute a group of conditions, including rheumatoid arthritis; systemic lupus erythematosus; mixed connective tissue disease; calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia (CREST) syndrome; scleroderma; dermatomyositis; and Sjögren syndrome. There are few studies on the alterations in filiform papillae in CTAD. Thus, the objective of this work was to determine whether there are changes in the macroscopic and dermoscopic patterns of filiform papillae. METHODS: This case-control study included patients who were diagnosed with CTAD. The dependent variable was the dermoscopic pattern of filiform papillae of the tongue, and the independent variables were age, gender, time of evolution, and current treatment. A photograph of the back of the tongue was taken, and subsequently, the same site was examined by dermatoscopy. The microscopic and dermoscopic patterns of filiform papillae were classified (Maeda). RESULTS: We included 50 cases and 50 controls, 94% of whom were female. The mean age was 43.96 ± 14.65 years. Of the cases with CTAD, 25% presented with a normal macroscopic pattern, versus 36% (18) with pattern II, 12% (6) with pattern III, and 20% (10) with pattern IV. The dermoscopic pattern was type I in 23 cases (46%), type II in 16 (32%), type III in 10 (20%), and type IV in one patient (2%). CONCLUSIONS: We have noted alterations in filiform papillae in CTADs, which emphasizes the importance of a detailed intraoral exploration and the macroscopic and dermoscopic evaluation of the dorsum of the tongue, specifically the filiform papillae.

Incidence of complications in dermatological surgery of melanoma and non-melanoma skin cancer in patients with multiple comorbidity and/or antiplatelet-anticoagulants. Five year experience in our Hospital. / Incidencia de complicaciones en cirugía dermatológica de cáncer de piel melanoma y no melanoma en pacientes con múltiple comorbilidad o antiagregantes-anticoagulantes. Experiencia de nuestro hospital durante 5 años

Introduction: Surgery is performed more frequently now at days, due to the increasing incidence of melanoma and no-melanoma skin cancer. There are different opinions among dermatologic surgeons between to continue or discontinue antithrombotic therapy prior to the procedure, which increases the risk of thromboembolic events. Prophylaxis with oral antibiotics in the postsurgical period is controversial. Objective: To report the safety of surgery without suspending antithrombotic therapy and without oral antibiotic prophylaxis in dermatology surgery of patients with multiple comorbidities and polypharmacy. Method: We designed a retrospective study. We included a total of 655 patients; 96.6% had at least one comorbidity; 27.7% used aspirin and 4.3% some type of antithrombotic therapy. The most common type of skin tumor was basal cell carcinoma with 69.8% . Results: The complication rate was 4.2%; the most was wound dehiscence (1.1%), followed by partial necrosis (0.9%), infection (0.9%), reaction to foreign body (0.6%), complete necrosis (0.3%), bleeding (0.2%) and fistulae (0.2%). Conclusions: Based on the literature and our experience, dermatologic surgery is safe without suspending antithrombotic therapy or antibiotic prophylaxis in patients with multiple comorbidity.

Introducción: La cirugía es uno de los procedimientos que se realizan con mayor frecuencia en dermatología debido a la mayor incidencia de cáncer de piel melanoma y no melanoma. Se han encontrado distintas posturas entre los cirujanos dermatólogos sobre continuar o suspender antiagregantes y anticoagulantes antes del procedimiento, lo cual incrementa el riesgo de eventos tromboembólicos, además de la preferencia de utilizar profilaxis antibiótica de forma posquirúrgica por algunos dermatólogos. Objetivo: Reportar nuestra experiencia en cuanto a la seguridad de la cirugía dermatológica sin la suspensión de anticoagulantes/antiagregantes y sin profilaxis antibiótica en pacientes con múltiple comorbilidad y polifarmacia. Método: Se revisaron 655 pacientes. El 96.6% tenían al menos otra enfermedad. El 27.7% utilizaba ácido acetilsalicílico y el 4.3% algún tipo de anticoagulante. El tipo de neoplasia más frecuente fue el carcinoma basocelular con 69.8%. Resultados: La tasa total de complicaciones fue del 4.2%. La complicación más frecuente fue la dehiscencia de la herida (1.1%), seguida de la necrosis parcial (0.9%), la infección (0.9%), la reacción a cuerpo extraño (0.6%), la necrosis total (0.3%), la hemorragia (0.2%) y la fístula cutánea (0.2%). Conclusiones: Basándonos en la literatura y nuestra experiencia, la cirugía dermatológica es segura sin suspender antitrombóticos ni indicar profilaxis antibiótica en pacientes con múltiple comorbilidad.

Horizontal and vertical sections of scalp biopsy specimens from dermatomyositis patients with scalp involvement.

BACKGROUND: The histologic findings of scalp involvement in dermatomyositis are not well characterized on account of a lack of large series. OBJECTIVE: To systematize the histologic features of scalp involvement in dermatomyositis on horizontal and vertical sections. METHODS: A descriptive, prospective, cross-sectional study recruited 31 patients with pathologically and serologically confirmed dermatomyositis in Mexico City, Mexico, from June 2014 to June 2015. A total of 36 scalp biopsy specimens from 20 patients with scalp involvement in dermatomyositis were processed as 20 vertical and 16 horizontal sections. RESULTS: Dilated capillaries and diffuse mucin deposition were detected in all biopsy specimens, followed by interface dermatitis. Partial or segmental thickening of the basement membrane, hyperkeratosis, atrophic epidermis, and acrosyringeal hypergranulosis with hyperkeratosis were other very common findings. Preserved follicular architecture, with intact or slightly atrophic sebaceous glands, was present in most horizontal sections. There was decreased follicular density, with a terminal-to-vellus ratio of 4:1 and telogen count of 10.3%. Eosinophils were present in 15% and 25% of horizontal and vertical sections, respectively. LIMITATIONS: No special stains performed. CONCLUSION: Scalp involvement in dermatomyositis shows nonscarring pattern on horizontal sections that is consistent with chronic telogen effluvium. Telangiectasia and mucin are universal histologic features; eosinophils and acrosyringeal hypergranulosis with hyperkeratosis are new findings.

Argyria after Silver Nitrate Intake: Case Report and Brief Review of Literature.

Argyria is a condition characterized by pigmentary changes secondary to exposure to silver salts and its accumulation in skin, mucous membranes and annexes, which typically produces blue or gray-blue spots. A case of a male patient 62 years old, previously healthy, who has a blue-gray hyperpigmentation on the face, trunk and upper extremity, affecting sun-exposed areas is presented. He admitted having ingested silver nitrate for 5 years at a rate of 1 bottle per week, with the intent to kill microorganisms in his body.

Hyperplasia and Hypertrophy of Pacinian Corpuscles: A Case Report.

The proliferation of Pacinian corpuscles is a rare benign lesion that occurs frequently in the fingers of hands, with the only clinical sign of pain when a drastic temperature change happens. A case of an extremely rare lesion in which we observed hypertrophy and hyperplasia of Pacinian corpuscles has been reported.

[Skin cancer in adults younger than 40 years at the General Hospital of Mexico]. / Cáncer de piel en pacientes menores de 40 años. Experiencia de cuatro años en el Hospital General de México.

Skin cancer is the most common malignant neoplasm reported worldwide. Over the last 20 years, skin cancer has been recognized in a high proportion among young people not associated with genetic disorders or other diseases. In Mexico there is no epidemiological information about this topic, so we made a retrospective study from 2006 to 2009 in the Dermatology service of the General Hospital of Mexico. We included 730 patients with diagnosis of primary skin cancer; 51 cases occurred in people younger than 40 years with an average age of 38 years, and with an estimated accumulated incidence of 6.8% for the elapsed time. In this study, skin cancer in young people showed a predominance of women (67% of patients); basal cell carcinoma was the most common type. Most of the lesions were found in sun-exposed areas. Skin cancer in people younger than 40 years is increasing dramatically, so we recommend avoiding ultraviolet radiation exposure in childhood and adolescence, and implementing sun-protection campaigns in order to educate this sector of the population and make them more aware of the potential dangers.