Basal cell carcinoma arising in outdoor workers versus indoor workers: a retrospective study.

Basal cell carcinoma (BCC) is the most prevalent malignancy in white individuals and continues to be a serious health problem. Individuals who have sustained exposure to UV radiation are at the highest risk for developing BCC. The aim of this study was to compare the features of BCC in outdoor workers (OWs) with a history of occupational exposure to UV radiation versus indoor workers (IWs). We found that OWs are more likely to develop nodular BCC with no increased risk for superficial BCC. The age of onset of BCC was older in OWs than in IWs. Truncal BCC was more common in IWs, which may suggest other etiological factors are involved in BCC such as genetic predisposition.

Basal cell carcinoma: analysis of factors associated with incomplete excision at a referral hospital in southern Spain.

Basal cell carcinoma (BCC) is the most prevalent malignancy, with excision as the best therapeutic approach. Incomplete excision of nonmelanoma skin cancer is a clinical indicator of the surgical technique performed. This retrospective study of 292 patients with BCC assessed the rate of incomplete excision in a tertiary referral hospital in southern Spain and its relationship with tumor location as well as histologic and surgical features.

Factors related to delay in the diagnosis of basal cell carcinoma.

BACKGROUND: There is often a delay between the clinical emergence of a basal cell carcinoma (BCC) and the point in time at which the patient presents for definitive diagnosis and treatment. Previously published studies on delays regarding skin cancer have focused on melanoma rather than BCC. We conducted a study aimed at identifying factors associated with the detection of BCC and reasons for the delay in diagnosis. METHOD: A monocentric study was performed. Patients with a primary BCC diagnosed in 2010 were included in the study. They were asked about factors concerning BCC awareness and detection, tumor characteristics, previous history of nonmelanoma cutaneous cancer, family history of nonmelanoma cutaneous cancer, and the presence of comorbidities. Data were analyzed using SPSS software. RESULTS: The mean diagnostic delay for BCC in our hospital setting was estimated at 19.79 ± 14.71 months. Delayed diagnosis was significantly associated with patients over 65 years, those without a previous history of BCC, those without a family history of BCC, those with BCC located elsewhere than the head or neck, and those with lesions not associated with itching or bleeding. CONCLUSION: This study revealed considerable delay in the diagnosis of BCC. The main reason for delay in the diagnosis seems to be the initial decision of the patient to seek medical advice. These data suggest a need for greater information for the general public on the symptoms and signs that should prompt suspicion of a BCC.

Alcohol intake and risk of aggressive histological basal cell carcinoma: a case-control study.

BACKGROUND: Aggressive basal cell carcinomas (BCC) are not rare. These subtypes of skin cancer are characterized by an infiltrative behavior and rapid progression. Often, management may be difficult. Recent evidence suggests that minimal UV exposure in combination with other behavioral and/or environmental factors may lead to higher incidence of BCC and, therefore, more risk of aggressive subtypes of this malignancy. Alcohol is a very commonly consumed beverage in Western societies, especially in association with outdoors activities. OBJECTIVE: To investigate a possible relationship between alcohol intake and aggressive histological variants of BCC. MATERIALS AND METHOD: We designed a prospective study. Patients who underwent surgery for BCC in our hospital were interviewed to collect data regarding alcohol intake. The specimens were reviewed by a pathologist and classified into aggressive and non-aggressive subtypes. Statistical analysis was performed using SPSS software. RESULTS: 136 patients were included. Of participants with aggressive BCCs, 10 (26.3%) were abstainers, 4 (10.4%) had light consumption, 18 (47.5%) moderate consumption and 6 (15.8%) heavy consumption, while among participants with non-aggressive BCCs, 57 (58.2%) were abstainers, 29 (29.5%) had light consumption, 10 (10.2%) moderate consumption and 2 (2.1%) heavy consumption. In the multivariate analysis we found a positive significant association between alcohol consumption and the presence of aggressive BBCs. CONCLUSIONS: According to our results, alcohol intake may be linked with a higher incidence of aggressive subtypes of BCC.

Effect of non-steroidal anti-inflammatory drugs on the histology of basal cell carcinomas.

BACKGROUND: Aggressive histology is not rare in BCC. Large studies from referral centers report incidences of aggressive histology BCC ranging from 2.5- 44%. These aggressive BCC are characterized by subclinical extension, invasive behavior, local recurrence and challenging treatment. OBJECTIVES: To examine the association between non-steroidal anti-inflammatory drug (NSAID) use and the different histological subtypes of basal cell carcinoma (BCC). METHODS: The design was a nested case-control study. The two population-based cohorts were of patients with a primary BCC diagnosis during January and May 2010 (n=136) and NSAID use in the 15 years prior to baseline. All the lesions were excised and analyzed to determinate the histological subtype of BCC as aggressive or non-aggressive. Odds ratios (ORs) and 95% confidence intervals (CIs), using conditional logistic regression, were calculated with the SPSS software to estimate the association of aggressive histological subtypes of BCC and use of NSAID. We controlled the potential confounding factors. RESULTS: The rate of non-aggressive BCC associated with exposure to NSAID was increased (OD: 0.34; 95% CI: 0.14-0.84) after adjusting for covariants. LIMITATIONS: our sample is small. We collected data regarding use of NSAID over a wide time ranges, so that we are unable to propose when the potential benefits of NSAID on the histology of BCC would happen. CONCLUSION: According to our data, NSAID exposure is associated with a decreased risk of aggressive BCC.

Androgenetic alopecia as an early marker of benign prostatic hyperplasia.

BACKGROUND: Androgenetic alopecia (AGA) and benign prostatic hyperplasia are both androgen-dependent entities that respond to the blocking of 5-alpha-reductase. OBJECTIVES: The objective of this study was to determine whether prostatic volumes and urinary flow changes were higher in patients with early-onset AGA than in healthy control subjects. METHODS: This was an observational case-control study of 87 men: 45 with early-onset AGA diagnosed in the dermatology department and 42 control subjects. End-point variables were prostatic volume, measured by transrectal ultrasound, and urinary flow, measured by urinary flowmetry. A hormone study was performed on all participants, and the International Prostate Symptom Score and International Index of Erectile Function score were determined. RESULTS: The groups did not significantly differ in mean age (cases, 52.7 years vs control subjects, 49.8 years; P = .12). Patients with AGA had significantly higher mean prostate volume (29.65 vs 20.24 mL, P < .0001), International Prostate Symptom Score (4.93 vs 1.23, P < .0001), and prostate-specific antigen value (1.53 vs 0.94 ng/mL, P < .0001) and significantly lower maximum urinary flow (14.5 vs 22.45 mL/s, P < .0001) versus control subjects. Binary logistic regression analysis showed a strong association between the presence of AGA and benign prostatic hyperplasia after adjusting for age, urinary volume, urination time, International Prostate Symptom Score, abdominal obesity, glucose levels, systolic blood pressure, insulin levels, fibrinogen, and C-reactive protein (odds ratio = 5.14, 95% confidence interval 1.23-47.36, P = .041). LIMITATIONS: The study of larger sample sizes would facilitate stratified analyses according to the Ebling type of androgenetic alopecia. CONCLUSION: There is a relationship between the presence of AGA and prostate growth-associated urinary symptoms, likely attributable to their pathophysiological similarity. This study suggests that early-onset AGA may be an early marker of urinary/prostatic symptomatology. Future studies may clarify whether treatment of patients with AGA may benefit the concomitant benign prostatic hypertrophy, which would be present at an earlier stage in its natural evolution.

Cardiovascular risk factors in patients with lichen planus.

BACKGROUND: Chronic inflammation was found to play an important role in the development of cardiovascular risk factors. Recently a case-control study found that lichen planus was associated with dyslipidemia in a large series of patients. However, no data were presented about lipid values, glucose levels, or blood pressure. OBJECTIVE: The objective of this case-control study was to evaluate cardiovascular risk factors included in Adult Treatment Panel III criteria for metabolic syndrome in men and women with lichen planus and in healthy controls. PATIENTS AND METHODS: This case-control study included 200 patients, 100 with lichen planus (50 men and 50 women) and 100 controls consecutively admitted to the outpatient clinic in Dermatology departments in Granada, Spain. RESULTS: Analysis of metabolic syndrome parameters revealed a higher significant prevalence of dyslipidemia in patients with lichen planus. No significant differences were observed in glucose levels, abdominal obesity, or blood pressure. Elevated levels of C-reactive protein, erythrocyte sedimentation rate, and fibrinogen were noted in patients with lichen planus. Adjusted odds ratio for dyslipidemia in patients with lichen planus was 2.85 (95% confidence interval, 1.33-5.09; P=.001). CONCLUSION: Chronic inflammation in patients with lichen planus may explain the association with dyslipidemia. Lipid levels screening in men or women with lichen planus may be useful to detect individuals at risk and start preventive treatment against the development of cardiovascular disease.

Sex hormone-binding globulin and risk of hyperglycemia in patients with androgenetic alopecia.

BACKGROUND: Low circulating levels of sex hormone-binding globulin (SHBG) are a strong predictor of the risk of type 2 diabetes. Androgenetic alopecia (AGA) has been related to an increase in cardiovascular risk, but the mechanism of this association has not been elucidated. AGA can be associated with low levels of SHBG and insulin resistance, which could be related to hyperglycemia and type 2 diabetes. OBJECTIVE: The objective of this study was to evaluate SHBG and blood glucose levels in men and women with early-onset AGA and control subjects to determine whether low levels of SHBG are associated with hyperglycemia. METHODS: This case-control study included 240 patients consecutively admitted to the outpatient clinic (Dermatology Department of San Cecilio University Hospital, Granada, Spain), 120 with early-onset AGA (60 men and 60 women) and 120 control subjects (60 men and 60 women) with skin diseases other than alopecia. RESULTS: Of patients with AGA, 39.1% presented with hyperglycemia (>110 mg/dL) versus 12.5% of controls (P < 0.0001). AGA patients with hyperglycemia or diabetes presented lower significant levels of SHBG than alopecic patients without hyperglycemia or type 2 diabetes, respectively. Patients with AGA and hyperglycemia presented significantly lower levels of SHBG than controls with hyperglycemia (22.3 vs 39.4 nmol/L for AGA patients and controls, respectively, P = .004). No significant differences in SHBG levels were noticed between patients and controls without hyperglycemia. Binary logistic regression showed a strong association between lower SHBG levels and glucose levels greater than 110 mg/dL in patients with AGA even after additional adjustment for sex, abdominal obesity, and free testosterone (odds ratio = 3.35; 95% confidence interval = 1.9-5.7; P < .001). LIMITATIONS: The study of a wider sample of AGA patients would confirm these findings and would permit analysis of the pathogenic mechanisms underlying the increase in cardiovascular risk in patients with AGA. CONCLUSION: An association between early-onset AGA, hyperglycemia/diabetes, and low levels of SHBG was observed in the current study. Low levels of SHBG could be a marker of insulin resistance and hyperglycemia/diabetes in patients with AGA.

A comparative study of dyslipidaemia in men and woman with androgenic alopecia.

Several studies have analyzed the relationship between androgenetic alopecia and cardiovascular disease (mainly heart disease). However few studies have analyzed lipid values in men and women separately. This case-control study included 300 patients consecutively admitted to an outpatient clinic, 150 with early onset androgenetic alopecia (80 males and 70 females) and 150 controls (80 males and 70 females) with other skin diseases. Female patients with androgenic alopecia showed significant higher triglycerides values (123.8 vs 89.43 mg/dl, p = 0.006), total cholesterol values (196.1 vs 182.3 mg/dl, p = 0.014), LDL-C values (114.1 vs 98.8 mg/dl, p = 0.0006) and lower HDL-C values (56.8 vs 67.7 mg/dl, p <0.0001) versus controls respectively. Men with androgenic alopecia showed significant higher triglycerides values (159.7 vs 128.7 mg/dl, p = 0.04) total cholesterol values (198.3 vs 181.4 mg/dl, p = 0.006) and LDL-C values (124.3 vs 106.2, p = 0.0013) versus non-alopecic men. A higher prevalence of dyslipidemia in women and men with androgenic alopecia has been found. The elevated lipid values in these patients may contribute, alongside other mechanisms, to the development of cardiovascular disease in patient with androgenic alopecia.

Androgenetic alopecia and cardiovascular risk factors in men and women: a comparative study.

BACKGROUND: Numerous studies in recent decades have associated male androgenetic alopecia (AGA) with the risk of cardiovascular disease. However, only 3 studies have addressed this association in female patients. Most studies considered the risk of myocardial infarction or mortality as a result of heart disease, without analyzing cardiovascular risk factors. OBJECTIVES: The objectives of this study were to analyze the presence of cardiovascular risk factors included in the Adult Treatment Panel-III criteria for metabolic syndrome, the prevalence of carotid atheromatosis, hormonal (aldosterone, insulin, testosterone, and sex hormone-binding globulin) factors, and acute phase reactant (C-reactive protein, fibrinogen, D-dimers, erythrocyte sedimentation rate) variables in male and female patients with AGA and in a control group, and to analyze differences among the groups. METHODS: This case-control study included 154 participants, 77 with early-onset AGA (40 male and 37 female) and 77 healthy control subjects (40 male and 37 female) from the dermatology department at a university hospital in Granada, Spain. RESULTS: Metabolic syndrome was diagnosed in 60% of male patients with AGA (odds ratio [OR] = 10.5, 95% confidence interval [CI] 3.3-32.5), 48.6% of female patients with AGA (OR = 10.73, 95% CI 2.7-41.2), 12.5% of male control subjects, and 8.1% of female control subjects (P < .0001). Atheromatous plaques were observed in 32.5% of male patients with AGA (OR = 5.93, 95% CI 1.5-22.9) versus 7.5% of male control subjects (P = .005) and 27% of female patients with AGA (OR = 4.19, 95% CI 1.05-16.7) versus 8.1% of female control subjects (P = .032). Aldosterone and insulin levels were significantly higher in the male and female patients with AGA versus their respective control subjects. Mean values of fibrinogen were significantly higher in male patients with AGA, whereas values of fibrogen, C-reactive protein, and D-dimers were significantly higher in female patients with AGA versus their respective control subjects. LIMITATIONS: The study of a wider sample of patients with AGA would confirm these findings and allow a detailed analysis of the above factors as a function of the degree of alopecia or between menopausal and premenopausal women. CONCLUSION: The determination of metabolic syndrome and ultrasound study of the carotid arteries may be useful screening methods to detect risk of developing cardiovascular disease in male and female patients with early-onset AGA and signal a potential opportunity for early preventive treatment.

Carcinoma sebáceo de localización facial: síndrome de Muir-Torre / Facial sebaceous carcinoma: Muir-Torre syndrome

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Syringocystoadenoma papilliferum associated with apocrine hidrocystoma and verruca.

Syringocystoadenoma papilliferum is a benign adnexal tumor usually located in head and neck that occurs during childhood or adolescence. A case of a syringocystoadema papilliferum associated with apocrine hydrocystoma and verruca is presented. It is unusual to see the occurrence of three histopathologic types of tumors coexisting in one cutaneous lesion.

Granuloma anular generalizado: respuesta al tratamiento con vitamina E / Generalized granuloma annulare: improvement with vitamin E therapy

Presentamos 2 pacientes de sexo femenino con granuloma anular generalizado confirmado histológicamente, sin respuesta a terapéuticas previas con corticoides tópicos, corticoides orales, inmunomoduladores, retinoides e inmunosupresores. En ambos casos se ha instaurado tratamiento con vitamina E, tópica en uno y oral en otro, con evolución favorable. En ningún caso se ha observado recurrencia de la dermatosis. Pensamos que el tratamiento con vitamina E, podría ser una posible alternativa a tener en cuenta ante granulomas anulares generalizados recalcitrantes

We present 2 female patients with generalized granuloma annulare confirmed histopathologically with no improvement after topical and oral steroids, immunomodulators, retinoids and immunosuppressive drugs. Vitamin E therapy was successfully performed in both cases, topical in the first one and oral in the other, with no following recurrence. We think that topical or oral vitamin E are possible alternatives to consider in the treatment of recalcitrant generalized granuloma annulare