ABSTRACT
Importance: The lymphatic and the hematogenous pathways have been proposed for disease progression in cutaneous melanoma, but association with recurrence has not been studied separately to date. Objective: To identify the risk factors associated with lymphatic and hematogenous metastasis. Design, Setting, and Participants: This retrospective cohort study included 1177 patients with malignant melanoma treated at Instituto Valenciano de Oncología, València, Spain. Data were retrieved from the melanoma database from January 1, 2000, through December 31, 2015, and analyzed from June 1 to 30, 2018. Exposure: Malignant melanoma at stages I to II. Main Outcomes and Measures: Analyses of survival free of lymphatic and hematogenous metastasis were performed using Kaplan-Meier curves and Cox proportional hazards regression. Results: For the 1177 patients included in the study analysis (51.1% women; median age at diagnosis, 55 years [interquartile range, 42-68 years), median follow-up was 75 months (interquartile range, 33-121 months); 108 (9.2%) developed lymphatic metastasis, and 108 (9.2%) developed hematogenous metastasis. In the multivariate analysis, being older than 55 years (hazard ratio [HR], 1.9; 95% CI, 1.2-3.1), tumor in the head/neck (HR, 1.7; 95% CI, 1.0-2.9) and acral locations (HR, 2.4; 95% CI, 1.3-4.5), greater Breslow thickness (HR for >4.00 mm, 5.4; 95% CI, 2.4-12.4), and presence of vascular invasion (HR, 3.2; 95% CI, 0.9-10.6) were associated with lymphatic spreading. Hematogenous metastasis was associated with greater Breslow thickness (HR for >4.00 mm, 10.4; 95% CI, 3.6-29.7), the absence of regression (HR, 0.1; 95% CI, 0.0-1.0), TERT promoter mutations (HR, 2.9; 95% CI, 1.5-5.7), and BRAF mutations (HR, 1.9; 95% CI, 1.1-3.6). Conclusions and Relevance: Risk factors associated with lymphatic and hematogenous metastasis differ. Follow-up and adjuvant treatment strategies may therefore need to be adapted to individual clinical, histopathologic, and molecular characteristics.
Subject(s)
Lymphatic Metastasis/pathology , Melanoma/pathology , Skin Neoplasms/pathology , Adult , Age Factors , Aged , Cohort Studies , Female , Humans , Longitudinal Studies , Male , Middle Aged , Neoplasm Staging , Retrospective Studies , Risk FactorsABSTRACT
Cutaneous apocrine adenocarcinoma (CAA) is a rare adnexal neoplasm that histologically can mimic breast carcinoma metastatic to the skin or apocrine carcinoma arising in ectopic breast tissue. It can present with a wide range of clinical modalities and can often simulate many benign processes, which delays its diagnosis and hinders its prognosis. We describe a case of a 33-year-old man who had a short-evolution small nodule in the right axilla with local lymph node metastases. The immunohistochemical characterization was closer to that of breast adenocarcinoma than to an adnexal neoplasm. This was established as the main differential diagnosis. Diagnosis of cutaneous apocrine adenocarcinoma may be difficult and immunomarkers are not specific. The anatomical criteria and systemic investigation are mandatory to establish the correct diagnosis.
Subject(s)
Adenocarcinoma/diagnosis , Breast Neoplasms, Male/diagnosis , Skin Neoplasms/diagnosis , Sweat Gland Neoplasms/diagnosis , Adult , Biomarkers, Tumor/analysis , Diagnosis, Differential , Humans , Immunohistochemistry , MaleABSTRACT
The cutaneous epithelioid angiomatous nodule is an uncommon benign vascular proliferation that has only recently been described. Clinically, it usually presents as a solitary, fast-growing, small reddish papulous or nodular lesion on the trunk or limbs of adults. Histopathologic study reveals a proliferation of epithelioid cells and predominantly solid, well delimited, unilobular growth in the superficial dermis. Well defined vessels are often found permeating the lesion, which also shows a certain degree of inflammatory infiltration. The cells contain abundant pink cytoplasm, often with vacuoles, and vesicular nuclei with prominent nucleoli. The morphology of these cells is relatively uniform, without atypia or pleomorphism, although mitoses are not uncommon. We report 2 new cases of cutaneous epithelioid angiomatous nodules, the first in a 28-year-old pregnant woman and the second in a 27-year-old man. In both cases, the usual characteristics of this entity were present, but with the peculiarity of a high mitotic index. We discuss the differential diagnosis of cutaneous epithelioid angiomatous nodules with other vascular proliferations that exhibit epithelioid cytology.
Subject(s)
Facial Neoplasms/pathology , Hemangioma/pathology , Pregnancy Complications, Neoplastic/pathology , Skin Neoplasms/pathology , Adult , Angiomatosis, Bacillary/diagnosis , Diagnosis, Differential , Facial Neoplasms/diagnosis , Female , Hemangioendothelioma, Epithelioid/diagnosis , Hemangioma/diagnosis , Hemangiosarcoma/diagnosis , Humans , Male , Pregnancy , Pregnancy Complications, Neoplastic/diagnosis , Shoulder , Skin Neoplasms/diagnosisABSTRACT
El eosinófilo es una célula efectora de la respuesta inmune con importante tropismo hacia los tejidos. Las enfermedades cutáneas en las que existe una infiltración tisular por eosinófilos constituyen un grupo aparentemente heterogéneo. Se realiza una revisión de las características principales de las enfermedades conocidas como dermatosis eosinofílicas. En esta primera parte del trabajo se incluye la foliculitis pustulosa eosinofílica, la celulitis eosinofílica, la hiperplasia angiolinfoide con eosinofilia, el granuloma facial, la úlcera eosinofílica de la mucosa oral, la papuloeritrodermia y la dermatitis eosinofílica paquidérmica. En analogía a la visión integradora aceptada para las dermatosis neutrofílicas se discutirá la posible unidad patogénica de este grupo de enfermedades (AU)
Subject(s)
Humans , Eosinophilia/complications , Dermatitis/immunology , Dermatitis, Exfoliative/immunology , Cellulite/immunology , Angiolymphoid Hyperplasia with Eosinophilia/immunologyABSTRACT
El lupus eritematoso neonatal es una enfermedad poco frecuente que se adquiere por vía transplacentaria. Puede afectar principalmente a la piel o al corazón y en el 10% de los casos a ambos órganos. Las lesiones cutáneas remiten espontáneamente, mientras que las cardíacas persisten sin mejoría y son mortales en el 10% de los casos pese a la implantación de un marcapasos. Presentamos el caso de una lactante de 4 meses con un lupus eritematoso neonatal que mostraba una afectación cutánea muy florida y afectación hepática sin repercusión clínica. El curso de la enfermedad fue indolente, con involución espontánea de las lesiones cutáneas, dejando hipopigmentación y telangiectasias, así como normalización de las transaminasas. Revisamos los aspectos más importantes de esta enfermedad (AU)
Subject(s)
Female , Infant , Humans , Lupus Erythematosus, CutaneousABSTRACT
La leishmaniasis comprende una serie de cuadros clínicos producidos por protozoos del género Leishmania, y sus manifestaciones dependen principalmente de la respuesta inmune del huésped. Su incidencia está aumentando en la última década entre los pacientes con SIDA; sin embargo, la asociación de leishmaniasis mucocutánea y VIH no es frecuente. Describimos el caso de un paciente varón de 54 años infectado por el VIH que desarrolló un cuadro de edematización e infiltración de labio superior y ulceración del labio inferior con afectación de ambas comisuras bucales y que tras estudio histológico fue diagnosticado de leishmaniasis mucocutánea. Se instauró tratamiento con antimoniales pentavalentes respondiendo de manera espectacular (AU)
