Spitzoid proliferative nodules arising in a congenital melanocytic naevus: A case report with clinical, dermoscopic and histologic correlation.

Proliferative nodules (PNs) are benign nodular proliferation of melanocytes occurring within congenital melanocytic naevi (CMN). Differential diagnosis between PN and melanoma is challenging for clinicians and pathologists. We describe the case of a 9-month-old boy who developed multiple nodules arising in a medium-sized CMN. Clinically, pink papules were observed, with dotted vessels on dermoscopy, suggesting spitzoid PN. On histopathological examination, the dermoscopic findings correlated with the vertical vessels of a spitzoid PN. Dermoscopy could be a useful tool to differentiate PN from melanoma. However, further studies describing the dermoscopic features of the different PN subtypes are needed. Histopathology remains the gold standard for definitive diagnosis aided by ancillary molecular tests such as fluorescence in situ hybridization or comparative genomic hybridization.

Incidence of Melanoma in Catalonia, Spain, Is Rapidly Increasing in the Elderly Population. A Multicentric Cohort Study.

The incidence of melanoma has been increasing worldwide during recent decades. The objective of the study was to analyse the trends in incidence for in situ and invasive melanoma in the Spanish region of Catalonia during the period of 2008-2017. We designed a cross-sectional study with an age-period-cohort analysis of melanoma patient data from the Network of Melanoma Centres in Catalonia. Our database covered a population of over seven million and included a total of 8626 patients with incident melanoma. The main outcome measures were crude and age-standardised incidence rates to the European 2013 standard population. Joinpoint regression models were used to evaluate the population trends. We observed an increase in the age-standardised incidence rate (per 100,000 population) of all melanoma subtypes from 11.56 in 2008 to 13.78 in 2017 with an average annual percent change (AAPC) of 3.5%. This incidence increase was seen exclusively in the older population. Moreover, the stratified analysis showed a statistically significant increase in the age-standardised incidence rate for invasive (AAPC 2.1%) and in situ melanoma (AAPC 6.5%). In conclusion, the incidence of melanoma has continued to increase in the elderly population over recent decades, with a rapidly increasing trend of in situ melanomas and the lentigo maligna subtype.

Increasing incidence of lentigo maligna and lentigo maligna melanoma in Catalonia.

BACKGROUND: Recent epidemiological studies suggest that past data where superficial spreading melanoma was by far the most common subtype of melanoma may not reflect current patterns of sun exposure or other risk factors more involved in other subtypes of melanoma as lentigo maligna (LM) or lentigo maligna melanoma (LMM). METHODS: In order to measure the current situation in our country, all cases of LM and LMM diagnosed in 23 hospitals in Catalonia, from 2000 to 2007, were recorded. RESULTS: Although for the global period LM/LMM represented only 8.4% of cases, an increasing trend in this percentage was observed throughout the study period (from 6.9% [27 cases] in 2000 to 13.1% [94 cases] in 2007). Also, an increasing incidence of LM/LMM was observed, especially in chronically sun-exposed areas (85.5% involving the head and neck region). During the 8 years of the registry, the mean Breslow thickness of LMM remained stable. However, the increase in the number of LM (in situ) cases was significantly higher than the increase of the invasive ones. CONCLUSIONS: An important observation from this data is that aging of population and current sun exposure patterns could keep increasing the incidence of LM/LMM, which may become an important public healthcare problem, over the other histological subtypes. In order to establish primary or secondary preventive measures to the LM/LMM risk-population, it is imperative to highlight the importance of chronic sun damage as a melanoma risk factor, and not only sunburn, most commonly addressed in melanoma prevention campaigns.

Anti-tumour necrosis factor-induced visceral and cutaneous leishmaniasis: case report and review of the literature.

BACKGROUND: Leishmaniasis is a chronic protozoan disease in which organisms are found within phagolysosomes of the mononuclear phagocyte system. There are three major forms: cutaneous, mucocutaneous and visceral. We report the first case of visceral leishmaniasis with cutaneous involvement in a patient with rheumatoid arthritis treated with the anti-tumour necrosis factor (anti-TNF) adalimumab. OBJECTIVE: To highlight cutaneous leishmaniasis as the first indicator of a kala-azar disease in a patient treated with anti-TNF and to review the literature on leishmaniasis in the context of anti-TNF therapy. CASE REPORT: A 59-year-old woman presented with a crusted plaque on the right elbow 34 months after the initiation of adalimumab. A cutaneous biopsy showed intracellular amastigotes. No Leishmania parasites were observed in a bone marrow aspirate, but laboratory tests showed anaemia and impaired liver function, abdominal ultrasonography showed hepatomegaly, and ELISA serology was strongly positive for Leishmania antibodies in serum and urine. Adalimumab was withdrawn and treatment combining intralesional pentavalent antimonials and liposomal amphotericin was started. Eight weeks later, the leishmaniasis had resolved. CONCLUSION: A skin biopsy disclosing leishmaniasis should prompt tests to rule out visceral leishmaniasis, especially in an area such as the Mediterranean where the prevalence of latent Leishmania infection is high.

Melanoma incidence increases in the elderly of Catalonia but not in the younger population: effect of prevention or consequence of immigration?

All cases of MM diagnosed in 23 hospitals in Catalonia, from 2000 to 2007 were recorded and melanoma incidence calculated and adjusted for the European standard population via the direct method. The age standardised rate/100,000 inhabitants varied from 6.74 in 2000 to 8.64 in 2007 for all melanomas and from 4.79 to 5.80 for invasive MMs; the Breslow thickness was stable during the period. The increase in invasive melanoma incidence in the elderly was remarkable, the crude rate/100,000 inhabitants increasing from 11.04 (2000) to 15.49 (2007) in the 60-64 year population, while remaining more stable in the 30-34 year range, from 3.97 in 2000 to 4.55 in 2007, and with a tendency to decrease from 5.1 in 2000 to 2.5 in 2007 for the age range of 25-29 years. These lower age ranges are much more affected by immigration. Despite the large immigrant population (nearly one million immigrants arrived in Catalonia during the study period from countries with a low melanoma incidence), melanoma incidence in our region has risen considerably and this trend is likely to persist in the near future.

Análisis farmacoeconómico de la pentoxifilina en úlceras venosas / Farmacoeconomic analyse of pentoxifylline in venous leg ulcers treatment

Introducción. El tratamiento con pentoxifilina oral es el tratamiento sistémico más estudiado para la resolución médica de las úlceras venosas y asociado a compresión ha demostrado ser más efectivo que la compresión aislada. Objetivo. Evaluar la eficiencia de 1.200 mg/día de pentoxifilina más vendaje compresivo en el tratamiento de las úlceras venosas. Materiales y métodos. Evaluación económica mediante un análisis de coste-efectividad. Los comparadores fueron la compresión combinada con el tratamiento oral con 1.200 mg/día de pentoxifilina y la terapia de ‘sólo compresión’. El ámbito de análisis fue el de la actuación ambulatoria en España y se consideraron dos horizontes temporales distintos para realizar la comparación, las 8 y las 24 semanas. La perspectiva del análisis fue la del Servicio Nacional de Salud. La asignación de probabilidades se realizó con datos de los ensayos clínicos publicados. Resultados. A las ocho semanas se cura el 33,33% de los pacientes con la terapia combinada y el 22,22% del grupo de terapia ‘sólo con compresión’. La terapia combinada resulta ser más coste-efectiva o eficiente, y el ratio coste-efectividad incremental (ICER) es de 282,1. A las 24 semanas con terapia combinada se cura un 63,31% de los pacientes frente al 45,39% con la terapia de ‘sólo con compresión’. La terapia combinada se mantiene como la más eficiente y resulta un ICER de 524,7. A través de los análisis de sensibilidad se comprueba que el modelo es robusto y que las conclusiones del análisis se mantienen frente a variaciones en el porcentaje de cura (entre un mínimo de 5 y un máximo de 10 puntos porcentuales) y en el coste de la cura de más de 9 euros. Conclusiones. El tratamiento asociado, vendaje compresivo más tratamiento farmacológico con 1.200 mg/día de pentoxifilina, además de más eficaz, es más coste-efectivo que el tratamiento de ‘sólo con compresión’ realizado en la terapia de las úlceras venosas

Introduction. The treatment with oral pentoxifylline is the most studied systemic treatment for the medical resolution of the venous ulcers. Moreover, when combined with compression, it has been proved to be more effective than the compression alone. Aim. To assess the efficiency of 1,200 mg/day of pentoxifylline plus a compressive bandage in the treatment of the venous ulcers. Materials and methods. Economic assessment through a cost-effectivity analysis. The comparators were the combined treatment of 1,200 mg/day of pentoxifylline plus compression therapy and the compression therapy alone. The scope of this study was out-patient treatment in Spain and the patients were assessed after both 8 and 24 weeks of treatment. The perspective of the analysis was that of the National Health Service. Model probabilities were obtained from published clinical trials. Results. At 8 weeks, 33.33% of patients using combined treatment were cured, versus 22.22% of the patients treated ‘only with compression’. The most cost-effective or efficient regimen was the combined treatment with an incremental cost-effectivity ratio (ICER) of 282.1. At 24 weeks, 63.31% of the patients using the combined treatment were cured, versus 45.39% of the patients treated ‘only with compression’. Again the most costeffective regimen was the combined treatment, this time with an ICER of 524.7. The sensitivity analyses performed show the robustness of the model and present conclusions are still valid for changes in the effectiveness of a minimum of 5 and a maximum of 10 percentual points. Also we can lower the cost of the cure material more than 9 euros without changing the most efficient regimen. Conclusions. The combined regimen, compressive therapy plus a pharmacological treatment with 1,200 mg/day of pentoxifylline, in addition to being more effective, is more cost-effective than the ‘compressive treatment alone’ when treating venous ulcers

Acral melanoma simulating warts: dermoscopic clues to prevent missing a melanoma.

BACKGROUND: Acral melanoma may adopt a variety of clinical characteristics simulating other tumors, ulcers, hemorrhage, or infections. In the Caucasian population health care providers often misdiagnose acral melanoma, and this is the cause of inadequate treatments. Clinical and dermoscopic clues can be easily recognized, which help to prevent missing a melanoma. OBJECTIVES: To study the clinical and dermoscopic findings in three cases of acral melanoma simulating warts that had been treated by dermatologists with curettage and cryotherapy. MATERIAL AND METHODS: Clinical and dermoscopic study of the tumors and review of the most frequent simulators of acral melanoma reported in the literature. RESULTS: In all three tumors, hyperkeratosis and the lack of specific pigmentation were observed. The parallel ridge pattern, revealed by dermoscopic examination, precipitated the recognition of acral melanoma. CONCLUSION: In these cases that presented atypical characteristics of acral lesions, therefore challenging the diagnostic process, dermoscopic examination helped to confirm an accurate diagnosis of acral melanoma.

Escorbuto: púrpura folicular como signo guía / Scurvy: follicular purpura as a diagnostic sign

El escorbuto es un cuadro clínico caracterizado por debilidad general, anemia, gingivitis y hemorragias cutáneas, secundario a una carencia de ácido ascórbico en la dieta. Actualmente, esta enfermedad constituye una rareza clínica, aunque todavía puede observarse en casos de desnutrición asociada a alcoholismo o a carencias dietéticas, especialmente en la infancia y la senectud. Presentamos el caso de un varón de 45 años que consultó por edemas en extremidades inferiores con púrpura folicular que se acompañaba de astenia, poliartralgias y gingivorragia. Tras la instauración de tratamiento con vitamina C 1 g/día el paciente presentó una rápida mejoría sintomática. El diagnóstico del escorbuto se basa en la sintomatología, la historia dietética y la rápida resolución del cuadro con la instauración de suplementos de vitamina C

Scurvy is a set of clinical manifestations characterized by general weakness, anemia, gingivitis and cutaneous bleeding, caused by a lack of ascorbic acid in the diet. This pathology is currently a clinical rarity, although it can still be seen in cases of malnutrition associated with alcoholism or with dietary deficiencies, especially in childhood and old age. We present the case of a 45-year-old male who consulted his physician because of lower limb edema with follicular purpura, accompanied by asthenia, polyarthralgia and bleeding gums. After treatment with 1 g/day of vitamin C was initiated, the patient's symptoms quickly improved. The diagnosis of scurvy was based on the patient's clinical symptoms, dietary history and the rapid resolution of the symptoms when vitamin C supplements were initiated