Melanoma in situ in Puerto Rico: clinical characteristics and detection patterns

The incidence of melanoma has been increasing worldwide since the early 1960's. Melanoma in situ in the earliest stage of melanoma which has been increasingly recognized in our population. We performed a retrospective study of the cases of melanoma in situ diagnosed between 1996 and 2002. Clinical characteristics and detection patterns were examined through the use of a questionnaire submitted to the dermatologist. 53% were males and 47% were women with a mean age of 57 years. The most common skin type was type III (35%). The majority of the lesions were on the head and neck region. Most patients detected their own melanoma (62%) while physicians detected 38%. Self detection occurred irrespective of the anatomic distribution with the exception of those presenting on the trunk area. No relation was found between the lesion size and the detection pattern. Patients younger than 70 year-old were more likely to detect their lesions than patients older than 70 year-old, in whom lesions were more frequently detected by their physicians. Routine skin self examination can improve the detection of melanoma when it is clinically a macule, a curable stage. Techniques about skin cancer prevention and self examination should be emphasized and taught by their physicians so that lesions of melanoma can be diagnosed in their earliest stage.

Neonatal lupus erythematosus.

This is a case of an infant with neonatal lupus erythematosus who presented the characteristic cutaneous lesions without evidence of systemic involvement. NLE is a rare condition which affects newborn infants from mothers who may me asymptomatic or have a connective tissue disease, with or without autoantibodies to extractable nuclear antigens Ro (SS-A), LA (SS-B) or ribonucleoproteins. The skin lesions are usually annular in configuration and resemble those of subacute cutaneous lupus erythematosus. Congenital complete heart block (CHB) may be present in addition to the cutaneous lesions. This is a review of NLE focusing on its clinical manifestations, serologic markers, pathogenesis and treatment.

Pigmented macules on palms and soles in Puerto Ricans.

BACKGROUND: One-third of melanomas in Puerto Ricans occur on the skin of palms and soles. This is a study to define the characteristics of melanocytic nevi in those locations. METHODS: A sample of 1,039 patients were randomly examined for pigmented macules on the palms and soles. After informed consent, biopsies of these lesions were done on 67 patients. RESULTS: Among the patients, 13% were found to have pigmented macules on the palms and soles. Volar melanocytic macule was the most frequent lesion. CONCLUSIONS: Melanocytic nevi occur frequently on volar skin. The criteria for removal of these lesions should not be different from those lesions at other locations.

Epidemiological study of tinea capitis in Puerto Rico.

Two separate studies were carried out to determine the dermatophytes responsible for tinea capitis in Puerto Rico. A retrospective study to determine those agents during the period between 1979 and 1989 revealed a total of 36 mycologically positive cases. The causative organisms consisted of the following species: M. canis, 14 cases (38.9%); T. mentagrophytes, 7 cases (19.4%); T. rubrum, 7 cases (19.4%); M. gypseum, 5 cases (13.9%); and T. tonsurans, T. verrucosum, unclassified Microsporum species, 1 case each (2.8% each). In a prospective study, fungal cultures were obtained from the scalps of 95 randomly selected children (45 males, 50 females) seen at the outpatient dermatology clinics of the Medical Sciences Campus of the University of Puerto Rico for a variety of skin problems but with no symptoms or signs of disease. One culture was positive for M. canis. All other cultures were negative. The significance of these findings is discussed as well as their relation to the incidence of T. tonsurans scalp infections in the Unites States.

[Malignant melanoma in Puerto Rico]. / Melanoma maligno en Puerto Rico.

An epidemiological study of malignant melanoma in Puerto Rico was done by reviewing the Puerto Rico Cancer Registry for all melanoma cases reported between the years 1981 to 1987. A total of 367 new cases were documented with the annual incidence ranging from 1.20 to 2.12 per 100,000 inhabitants with a mean of 1.59. Most of the patients were between 40 and 80 years of age with a peak in the sixties. Nearly one half of the tumors were located on the extremities, most notably on the feet, sharing this predilection with Blacks and Japanese. The most frequently recognized clinico-histologic type was the superficial spreading melanoma followed by the acral lentiginous, the nodular and the lentigo maligna melanoma. Nearly one third of the total cases were not classified according to the histologic type, while Clark's levels and Breslow's thickness were not reported in 44 and 84% of the cases, respectively. When compared to a previous study during 1977 to 1980, the average annual incidence of new cases increased from 0.92 to 1.59 per 100,000 documenting an increased incidence of the condition in our population, but not as significant as that registered in the United States.

Intralesional steroids in cutaneous hemangioma.

Cutaneous hemangiomas are present in 2.6% of all newborn children. Conservative management is the preferred method of treatment, and only cases with a high risk of complications should be treated. Periocular cutaneous hemangiomas have been associated with ophthalmic complications in 41%-100% of such cases. Intralesional steroids are frequently used by ophthalmologists for treatment of periocular hemangiomas. We present a case of cutaneous hemangioma treated with this modality. No previous cases have been reported in the dermatologic literature. A review, description, and complications of the use of intralesional steroids in hemangiomas are included.

Sclerodermiform linear atrophy after the use of intralesional steroids for periorbital hemangiomas: a review of complications.

A 1-year-old girl developed a linear atrophy 3 months after a second injection of intralesional steroids for a periorbital hemangioma, followed by spontaneous resolution of the atrophy within 13 months. Reported and potential complications of intralesional steroids for periorbital hemangiomas are reviewed.

[Papulopustular eruption in intestinal inflammatory disease]. / Erupción papulopustular en enfermedad inflamatoria del intestino.

We report a patient that fulfills the clinical features of inflammatory bowel disease (Crohn) who develops papulopustular lesions, some of which evolve into erythematous plaques with pustules and other into superficial ulcers. The different cutaneous manifestations of inflammatory bowel disease, are reviewed, an entity which includes Crohn's disease and ulcerative colitis, as well as the previously reported cases which developed papulopustular lesions emphasizing their similarities and their differences to our patients and also its probable relationship to malignant pyoderma.

Recent concepts in human papillomavirus.

The human papillomavirus (HPV) belongs to a small group of viruses which are known to cause tumors in humans. Not only do they cause benign papillomas, but they are also implicated in the pathogenesis of some malignancies. For this reason, it is important for both the practicing physicians and students to know about recent advances in the study of these viruses. The following is a review of the etiologic role of HPV in non-genital and genital warts, laryngeal papillomas, and their possible roles in several malignancies.