Low-Level Expression of p-S6 Is Associated with Nodal Metastasis in Patients with Head and Neck Cutaneous Squamous Cell Carcinoma.

Cutaneous squamous cell carcinoma (cSCC) is the second most common form of skin cancer. The incidence of metastasis for cSCC is estimated to be around 1.2-5%. Ribosomal protein S6 (p-S6) and the p21 protein (p21) are two proteins that play central roles in other cancers. These proteins may be equally important in cSCC, and together, these could constitute a good candidate for metastasis risk assessment of these patients. We investigate the relationship of p-S6 and p21 expression with the impact on the prognosis of head and neck cSCC (cSCCHN). p-S6 and p21 expression was analyzed by immunohistochemistry on paraffin-embedded tissue samples from 116 patients with cSCCHN and associations sought with clinical characteristics. Kaplan-Meier estimators and Cox proportional hazard regression models were also used. The expression of p-S6 was significantly inversely associated with tumor thickness, tumor size, desmoplastic growth, pathological stage, perineural invasion and tumor buds. p21 expression was significantly inversely correlated with >6 mm tumor thickness, desmoplastic growth, and perineural invasion. p-S6-negative expression significantly predicted an increased risk of nodal metastasis (HR = 2.63, 95% CI 1.51-4.54; p < 0.001). p21 expression was not found to be a significant risk factor for nodal metastasis. These findings demonstrate that p-S6-negative expression is an independent predictor of nodal metastasis. The immunohistochemical expression of p-S6 might aid in better risk stratification and management of patients with cSCCHN.

Psoriasis of the external auditory canal: prevalence, clinical features and impact on quality of life.

Psoriasis of the external auditory canal (PsEAC) is often under-recognized. The aims of this study were to assess the prevalence of PsEAC, its association with a particular psoriasis subtype and its impact on quality of life (QoL). A prospective study was carried out in two Spanish university hospitals, enrolling consecutive patients who attended a consultation for psoriasis. The clinical features of psoriasis and PsEAC were recorded and the Dermatology Life Quality Index (DLQI) and Itch Numerical Rating Scale (Itch-NRS) were distributed to patients. Overall, 188 of 1000 patients (18.8%) included in the study had PsEAC, which was associated with severity of psoriasis, presence of inverse psoriasis and involvement of the scalp, nails and genitals, but not with obesity or psoriatic arthritis. PsEAC was the main reason for consultation in 27 patients, with itching being the main symptom. In this study, PsEAC had a prevalence of 18.8%. The occurrence of PsEAC was associated with poorer QoL, as measured by DLQI and Itch-NRS.

Nódulo subcutáneo doloroso / Painful subcutaneous nodule

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The adverse prognostic effect of tumor budding on the evolution of cutaneous head and neck squamous cell carcinoma.

BACKGROUND: Tumor budding is a readily detectable histopathologic feature that has been recognized as an adverse prognostic factor in several human cancers. OBJECTIVE: We sought to assess the correlation of tumor budding with the clinicopathologic features and the prognostic value of tumor budding in cutaneous squamous cell carcinoma (cSCC). METHODS: Forty-nine primary nonmetastatic and 49 primary metastatic cSCCs to regional lymph nodes were retrospectively studied. Statistical analyses were carried out to assess the relationship between tumor budding, clinicopathologic parameters, and patient survival. RESULTS: Tumor budding was observed in 45 cases of 98 (46%). High-intensity budding (≥5 tumor buds) was observed in 20 tumors. Presence of tumor buds was a significant risk factor for nodal metastasis with crude and adjusted hazard ratios (HRs) of 8.92 (95% CI, 4.39-18.1) and 6.93 (95% CI, 3.30-14.5), respectively, and for reduced overall survival time (crude and adjusted HRs of 2.03 [95% CI, 1.26-3.28] and 1.72 [95% CI, 1.05-2.83], respectively). LIMITATIONS: This was a retrospective study limited to cSCCs of the head and neck. Examined tumors were >2 mm thick, and all were from a primary excision. CONCLUSION: These results indicate an increased frequency of nodal metastasis and risk of death in patients with tumor buds.

Epithelioid angiosarcoma of the skin. A malignant tumor mimicking many different neoplasms.

Epithelioid angiosarcomas are rare malignant mesenchymal tumors. The main problem of these tumors is the complicate clinical and histological diagnosis. We report a case with an immunohistochemical panel. We propose the use of CD31 in the immunohistochemical panel of an undifferenciated tumor with epithelioid features, because it appears to be the only endothelial marker these tumors constantly express.

Zosteriform cutaneous metastasis from a breast carcinoma

Las metástasis cutáneas de carcinomas internos son infrecuentes y con patrón zosteriforme son raras. Para estudiar las características de las metástasis zosteriformes estudiamos 38 casos de la literatura y una paciente vista en nuestro Servicio. Métodos: Estudiamos la edad y sexo de cada paciente, la localización del tumor primario, la anatomía patológica del primario y las lesiones cutáneas, localización de las lesiones cutáneas y presencia o ausencia de dolor en los 39 casos. Resultados: La localización más frecuente del cáncer primario fue la mama (7 pacientes) y el carcinoma escamoso de piel (6 pacientes). El sitio más común de las metástasis en la piel fue la pared abdominal (21 pacientes). Conclusión: Esta revisión realza la importancia de incluir las metástasis cutáneas dentro del diagnóstico diferencial de las enfermedades con distribución zosteriforme. Se deben considerar las metástasis cutáneas y es necesario realizar una biopsia de piel para confirmar el diagnóstico. Nosotros pensamos que este patrón de enfermedad metastásica es más frecuente de lo recogido en la literatura

Cutaneous metastases from internal malignancies or primary skin cancers are uncommon, and a zosteriform pattern is very rare. In order to elucidate the characteristics of zosteriform metastatic skin cancer we reviewed 38 cases from the medical literature and 1 case seen in our clinic. Methods: The age and sex of each patient, location of the primary tumor, pathology of primary and metastatic lesions, location of the skin cancer and presence of pain were determined for the 39 cases. Results: The most frequent site of the primary tumor was the breast (7 cases) and skin squamous all carcinoma (6 cases). The most common site of the skin metastases was the chest wall (21 cases). Conclusion: This review highlights the importance of including cutaneous metastases within the differential diagnosis of zosteriform eruptions. Skin metastases should be considered and a skin biopsy is necessary to confirm the diagnosis. We think that this pattern of metastatic disease is more frequent than is indicated in the literature

[Becker's nevus associated with epidermal nevus: another example of twin spotting?]. / Nevo de Becker asociado a nevo epidérmico: 'un ejemplo más de "manchas gemelas"?

Linear epidermal nevi are believed to be caused by an autosomal dominant lethal mutation that can only be expressed by mosaicism. Becker's nevus can be explained by paradominant inheritance which is only manifested clinically by an acquired loss of heterozygosity. We present the case of a 16-year-old female with an epidermal nevus located on the left side of the neck, and also a Becker's nevus located on the ipsilateral shoulder. It is interesting to speculate that this supposed double mosaicism could be another example of "twin spotting" or non-allelic didymosis, although the possibility that this is a chance association cannot be ruled out, as the lesions are not closely associated.

Nevo de Becker asociado a nevo epidérmico: ¿un ejemplo más de «manchas gemelas»? / Becker’s nevus associated with epidermal nevus: another example of twin spotting?

El nevo epidérmico lineal se presume debido a un gen letal autosómico dominante que únicamente puede expresarse en situación de mosaicismo. El nevo de Becker puede explicarse mediante una herencia paradominante que sólo se manifiesta clínicamente por una pérdida adquirida de heterozigosidad. Presentamos una mujer de 16 años con un nevo epidérmico localizado en la zona izquierda del cuello y además un nevo de Becker localizado en el hombro ipsolateral. Resulta interesante explicar esta observación de un supuesto doble mosaicismo en términos de un ejemplo más de «manchas gemelas» o didimosis no alélica aunque no puede descartarse que dicha asociación se deba al azar, ya que las lesiones no se encuentran en íntima aposición

Linear epidermal nevi are believed to be caused by an autosomal dominant lethal mutation that can only be expressed by mosaicism. Becker's nevus can be explained by paradominant inheritance which is only manifested clinically by an acquired loss of heterozygosity. We present the case of a 16-year-old female with an epidermal nevus located on the left side of the neck, and also a Becker's nevus located on the ipsilateral shoulder. It is interesting to speculate that this supposed double mosaicism could be another example of «twin spotting» or non-allelic didymosis, although the possibility that this is a chance association cannot be ruled out, as the lesions are not closely associated

Síndrome de Kindler: aportación de un caso / Kindler syndrome: presentation of a case

El síndrome de Kindler, es una enfermedad muy poco frecuente debida a mutaciones que originan defectos en la unión actina-matriz extracelular. Suele cursar con ampollas acrales desde el nacimiento en zonas más expuestas a los traumatismos, fotosensibilidad marcada que mejora con la edad y desarrollo de poiquilodermia y atrofia cutánea. Con relativa frecuencia se describe afectación de mucosas y degeneración maligna

Kindler syndrome is a very rare disease caused by mutations resulting in defects in the extracellular matrix-actin link. It usually presents with acral blistering from birth in trauma-prone areas, pronounced photosensitivity that improves with age and the development of poikiloderma and cutaneous atrophy. Mucosal involvement and degeneration have been described with relative frequency

Prurigo pigmentoso / Prurigo pigmentosa

El prurigo pigmentoso es una dermatosis inflamatoria infrecuente de etiología desconocida caracterizada por episodios recurrentes de pápulas eritematosas y pruriginosas que evolucionan hacia una intensa pigmentación reticulada. Se ha referido más frecuentemente en mujeres adultas jóvenes en Japón. Sólo se han descrito fuera de Japón unos 30 casos. Describimos una paciente española de 32 años que desarrolló una dermatosis pruriginosa con las características clínicas y hallazgos histopatológicos del prurigo pigmentoso. Se revisan las características epidemiológicas, clínicas e histopatológicas de esta peculiar enfermedad cutánea

Prurigo pigmentosa is an infrequent inflammatory dermatosis of unknown etiology, characterized by recurrent episodes of pruritic erythematous papules which develop into intense reticulated pigmentation. It has been referenced most frequently in young women in Japan. Only thirty cases have been described outside of Japan. We describe a 32-year-old Spanish female who developed a pruritic dermatosis with the clinical characteristics and histopathological findings of prurigo pigmentosa. We review the epidemiological, clinical and histopathological characteristics of this peculiar skin disease

"Manos de mecánico" como signo cutáneo característico del síndrome de antisintetasa / Mechanic´s hands: a characteristic cutaneous sign of antisynthetase syndrome

Las «manos de mecánico» constituyen un signo cutáneo característico de miositis inflamatoria idiopática. Se describe el caso de un paciente varón de 61 años que fue diagnosticado en el año 1999 de polimiositis idiopática y enfermedad pulmonar intersticial inespecífica y que 3 años después desarrolló unas lesiones hiperqueratósicas, escamosas y fisuradas en las caras laterales y caras palmares de los primeros 3 dedos de ambas manos, escasamente pruriginosas. La presencia en el suero del paciente del anticuerpo antisintetasa anti-Jo-1, el hallazgo de lesiones cutáneas de «manos de mecánico» y el resto de manifestaciones clínicas sistémicas del paciente permiten establecer el diagnóstico de «síndrome antisintetasa»

«Mechanic’s hands» are a characteristic cutaneous sign of idiopathic inflammatory myositis. We describe the case of a 61-year-old male patient who was diagnosed with idiopathic polymyositis and non-specific interstitial lung disease in 1999, and three years later developed scaly, fissured hyperkeratotic lesions on the lateral and palmar surfaces of the first three fingers of both hands, with little pruritus. The presence of the anti-Jo-1 antisynthetase antibody in the patient’s serum, the finding of skin lesions characteristic of «mechanic’s hands» and the patient’s other systemic clinical manifestations made it possible to establish the diagnosis of «antisynthetase syndrome»

Haemorrhagic cellulitis caused by Salmonella enteritidis.

Soft tissue infections are rare manifestations of extra-intestinal salmonellosis and occur more frequently in immunocompromized patients [1-4]. We report haemorrhagic cellulitis in an immunosuppressed patient with sepsis caused by a non-typhoid Salmonella.

[Prurigo pigmentosa]. / Prurigo pigmentoso.

Prurigo pigmentosa is an infrequent inflammatory dermatosis of unknown etiology, characterized by recurrent episodes of pruritic erythematous papules which develop into intense reticulated pigmentation. It has been referenced most frequently in young women in Japan. Only thirty cases have been described outside of Japan. We describe a 32-year-old Spanish female who developed a pruritic dermatosis with the clinical characteristics and histopathological findings of prurigo pigmentosa. We review the epidemiological, clinical and histopathological characteristics of this peculiar skin disease.

[Kindler syndrome: presentation of a case]. / Síndrome de Kindler: aportación de un caso.

Kindler syndrome is a very rare disease caused by mutations resulting in defects in the extracellular matrix-actin link. It usually presents with acral blistering from birth in trauma-prone areas, pronounced photosensitivity that improves with age and the development of poikiloderma and cutaneous atrophy. Mucosal involvement and degeneration have been described with relative frequency.