Consenso de terminología en microscopia confocal de reflectancia en español mediante método Delphi / Reflectance Confocal Microscopy Terminology in Spanish: A Delphi Consensus Study

La terminología usada para describir los diferentes hallazgos en la microscopía confocal de reflectancia (MCR), tanto en lesiones melanocíticas, como en no melanocíticas se ha consensuado en inglés. En el presente trabajo, se proponen los términos en español que mejor interpretan estos conceptos ya descritos para la MCR, mediante el consenso de expertos de distintas nacionalidades de habla hispana y utilizando el método DELPHI para el acuerdo final. Se obtuvieron 52 términos en total, de los cuales 28 fueron para lesiones melanocíticas y 24 para lesiones no melanocíticas. El uso de la nomenclatura propuesta permitirá una homogeneización y mejor entendimiento de las estructuras; una descripción más estandarizada en los registros clínicos y una mejor interpretación de estos informes por otros dermatólogos.(AU)

The terminology used to describe reflectance confocal microscopy (RCM) findings in both melanocytic and nonmelanocytic lesions has been standardized in English. We convened a panel of Spanish-speaking RCM experts and used the Delphi method to seek consensus on which Spanish terms best describe RCM findings in this setting. The experts agreed on 52 terms: 28 for melanocytic lesions and 24 for nonmelanocytic lesions. The resulting terminology will facilitate homogenization, leading to a better understanding of structures, more standardized descriptions in clinical registries, and easier interpretation of clinical reports exchanged between dermatologists.(AU)

[Translated article] Reflectance Confocal Microscopy Terminology in Spanish: A Delphi Consensus Study / Consenso de terminología en microscopia confocal de reflectancia en español mediante método Delphi

La terminología usada para describir los diferentes hallazgos en la microscopía confocal de reflectancia (MCR), tanto en lesiones melanocíticas, como en no melanocíticas se ha consensuado en inglés. En el presente trabajo, se proponen los términos en español que mejor interpretan estos conceptos ya descritos para la MCR, mediante el consenso de expertos de distintas nacionalidades de habla hispana y utilizando el método DELPHI para el acuerdo final. Se obtuvieron 52 términos en total, de los cuales 28 fueron para lesiones melanocíticas y 24 para lesiones no melanocíticas. El uso de la nomenclatura propuesta permitirá una homogeneización y mejor entendimiento de las estructuras; una descripción más estandarizada en los registros clínicos y una mejor interpretación de estos informes por otros dermatólogos.(AU)

The terminology used to describe reflectance confocal microscopy (RCM) findings in both melanocytic and nonmelanocytic lesions has been standardized in English. We convened a panel of Spanish-speaking RCM experts and used the Delphi method to seek consensus on which Spanish terms best describe RCM findings in this setting. The experts agreed on 52 terms: 28 for melanocytic lesions and 24 for nonmelanocytic lesions. The resulting terminology will facilitate homogenization, leading to a better understanding of structures, more standardized descriptions in clinical registries, and easier interpretation of clinical reports exchanged between dermatologists.(AU)

Reflectance Confocal Microscopy Terminology in Spanish: A Delphi Consensus Study. / Consenso de terminología en microscopia confocal de reflectancia en español mediante método Delphi.

The terminology used to describe reflectance confocal microscopy (RCM) findings in both melanocytic and nonmelanocytic lesions has been standardized in English. We convened a panel of Spanish-speaking RCM experts and used the Delphi method to seek consensus on which Spanish terms best describe RCM findings in this setting. The experts agreed on 52 terms: 28 for melanocytic lesions and 24 for nonmelanocytic lesions. The resulting terminology will facilitate homogenization, leading to a better understanding of structures, more standardized descriptions in clinical registries, and easier interpretation of clinical reports exchanged between dermatologists.

Utilidad de la microscopía confocal de reflectancia para el diagnóstico in vivo de los sebomatricomas / Usefulness of Reflectance Confocal Microscopy For in Vivo Diagnosis of Sebomatricomas

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Effectiveness of Wyoming's Sage-Grouse Core Areas: Influences on Energy Development and Male Lek Attendance.

Greater sage-grouse (Centrocercus urophasianus) populations have declined across their range due to human-assisted factors driving large-scale habitat change. In response, the state of Wyoming implemented the Sage-grouse Executive Order protection policy in 2008 as a voluntary regulatory mechanism to minimize anthropogenic disturbance within defined sage-grouse core population areas. Our objectives were to evaluate areas designated as Sage-grouse Executive Order Core Areas on: (1) oil and gas well pad development, and (2) peak male lek attendance in core and non-core sage-grouse populations. We conducted our evaluations at statewide and Western Association of Fish and Wildlife Agencies management zone (MZ I and MZ II) scales. We used Analysis of Covariance modeling to evaluate change in well pad development from 1986-2014 and peak male lek attendance from 958 leks with consistent lek counts within increasing (1996-2006) and decreasing (2006-2013) timeframes for Core and non-core sage-grouse populations. Oil and gas well pad development was restricted in Core Areas. Trends in peak male sage-grouse lek attendance were greater in Core Areas compared to non-core areas at the statewide scale and in MZ II, but not in MZ I, during population increase. Trends in peak male lek attendance did not differ statistically between Core and non-core population areas statewide, in MZ I, or MZ II during population decrease. Our results provide support for the effectiveness of Core Areas in maintaining sage-grouse populations in Wyoming, but also indicate the need for increased conservation actions to improve sage-grouse population response in MZ I.

La microscopía confocal de reflectancia en el lentigo maligno / Reflectance confocal microscopy in lentigo maligna

El lentigo maligno es el melanoma más frecuente en la cara. El diagnóstico del lentigo maligno es complicado porque los signos clínicos y dermatoscópicos asociados a lentigo maligno pueden verse en otras lesiones cutáneas faciales. La microscopia confocal de reflectancia es una técnica de imagen que permite detectar hallazgos característicos del lentigo maligno. En la epidermis encontramos la pérdida del patrón en panal de abejas y células pagetoides con tendencia al foliculotropismo. Estas células pagetoides suelen ser de morfología dendrítica, aunque también pueden presentarse como células redondas mayores de 20μm con núcleos atípicos. En la unión dermoepidérmica las papilas dérmicas pueden estar mal delimitadas y haber células atípicas. Estas células pueden formar puentes que parecen estructuras mitocondriales. Además, podemos ver engrosamientos junturales con células atípicas localizados alrededor de los folículos simulando una cabeza de medusa. La microscopia confocal de reflectancia es muy útil en el diagnóstico del lentigo maligno

Lentigo maligna is the most common type of facial melanoma. Diagnosis is complicated, however, as it shares clinical and dermoscopic characteristics with other cutaneous lesions of the face. Reflectance confocal microscopy is an imaging technique that permits the visualization of characteristic features of lentigo maligna. These include a disrupted honeycomb pattern and pagetoid cells with a tendency to show folliculotropism. These cells typically have a dendritic morphology, although they may also appear as round cells measuring over 20μm with atypical nuclei. Poorly defined dermal papillae and atypical cells may be seen at the dermal-epidermal junction and can form bridges resembling mitochondrial structures. Other characteristic findings include junctional swelling with atypical cells located around the follicles, resembling caput medusae. Reflectance confocal microscopy is a very useful tool for diagnosing lentigo maligna

Lesión melanocítica con patrón globular con cambios en el seguimiento a corto plazo / Melanocytic lesion with a globular pattern showing changes during short-term follow-up

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Reflectance Confocal Microscopy in Lentigo Maligna. / La microscopía confocal de reflectancia en el lentigo maligno.

Lentigo maligna is the most common type of facial melanoma. Diagnosis is complicated, however, as it shares clinical and dermoscopic characteristics with other cutaneous lesions of the face. Reflectance confocal microscopy is an imaging technique that permits the visualization of characteristic features of lentigo maligna. These include a disrupted honeycomb pattern and pagetoid cells with a tendency to show folliculotropism. These cells typically have a dendritic morphology, although they may also appear as round cells measuring over 20µm with atypical nuclei. Poorly defined dermal papillae and atypical cells may be seen at the dermal-epidermal junction and can form bridges resembling mitochondrial structures. Other characteristic findings include junctional swelling with atypical cells located around the follicles, resembling caput medusae. Reflectance confocal microscopy is a very useful tool for diagnosing lentigo maligna.

Utilidad de la microscopia confocal en el diagnóstico diferencial de epiteliomas basocelulares y nevus melanocíticos intradérmicos de localización facial / Usefulness of Confocal Microscopy in Distinguishing Between Basal Cell Carcinoma and Intradermal Melanocytic Nevus on the Face

El diagnóstico clínico diferencial entre el epitelioma basocelular y el nevus melanocítico intradérmico facial puede ser a veces complicado, sobre todo en pacientes jóvenes o con múltiples nevus. La dermatoscopia es una herramienta útil que permite observar signos dermatoscópicos asociados a epitelioma como las ruedas de carro, las hojas de arce, los nidos y puntos azul grisáceos y la ulceración, además permite distinguir los vasos telangiéctasicos arboriformes y los vasos cortos curvados bien enfocados característicos de los epiteliomas basocelulares de los vasos en coma presentes en los nevus melanocíticos intradérmicos. Sin embargo, el diagnóstico diferencial clínico y dermatoscópico entre estas 2 afecciones dermatológicas puede ser complejo. Presentamos 2 lesiones faciales en 2 pacientes de 38 años de difícil diagnóstico clínico y dermatoscópico en los que la microscopia confocal mostró nidos celulares con separación entre los nidos y el estroma, y polarización de los núcleos de las células tumorales, que son signos confocales asociados a epitelioma basocelular

The clinical distinction between basal cell carcinoma (BCC) and intradermal melanocytic nevus lesions on the face can be difficult, particularly in young patients or patients with multiple nevi. Dermoscopy is a useful tool for analyzing characteristic dermoscopic features of BCC, such as cartwheel structures, maple leaf–like areas, blue-gray nests and dots, and ulceration. It also reveals arborizing telangiectatic vessels and prominent curved vessels, which are typical of BCC, and comma vessels, which are typical of intradermal melanocytic nevi. It is, however, not always easy to distinguish between these 2 conditions, even when dermoscopy is used. We describe 2 facial lesions that posed a clinical and dermoscopic challenge in two 38-year-old patients; confocal microscopy showed separation between tumor nests and stroma and polarized nuclei, which are confocal microscopy features of basal cell carcinoma

Usefulness of confocal microscopy in distinguishing between basal cell carcinoma and intradermal melanocytic nevus on the face.

The clinical distinction between basal cell carcinoma (BCC) and intradermal melanocytic nevus lesions on the face can be difficult, particularly in young patients or patients with multiple nevi. Dermoscopy is a useful tool for analyzing characteristic dermoscopic features of BCC, such as cartwheel structures, maple leaf-like areas, blue-gray nests and dots, and ulceration. It also reveals arborizing telangiectatic vessels and prominent curved vessels, which are typical of BCC, and comma vessels, which are typical of intradermal melanocytic nevi. It is, however, not always easy to distinguish between these 2 conditions, even when dermoscopy is used. We describe 2 facial lesions that posed a clinical and dermoscopic challenge in two 38-year-old patients; confocal microscopy showed separation between tumor nests and stroma and polarized nuclei, which are confocal microscopy features of basal cell carcinoma.

Hematoma profundo disecante o estadio IV de dermatoporosis / Deep dissecting hematoma or stage IV dermatoporosis

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Linfoma cutáneo de células B del centro folicular tratado con rituximab intralesional / Cutaneous follicular center B-cell lymphoma treated with intralesional rituximab

Los linfomas cutáneos de células B del centro folicular son tumores indolentes compuestos por células neoplásicas del centro folicular. Están constituidos por una mezcla de centrocitos con un número variable de centroblastos. Los tratamientos habitualmente utilizados son la cirugía y la radioterapia, aunque se utilizan otros como el interferón-a (IFN-a), la quimioterapia y tratamientos biológicos (rituximab). El rituximab es un anticuerpo monoclonal quimérico anti-CD20. Puede utilizarse por vía intravenosa o intralesional. Presentamos el caso de un paciente varón de 41 años que consultó por lesiones nodulares violáceas en el área escapular izquierda y que, tras la realización de una biopsia, analítica, tomografía axial computarizada (TAC) toracoabdominopélvica, ecografía abdominal y biopsia de médula ósea fue diagnosticado de linfoma cutáneo de células B del centro folicular. Se decidió tratamiento con 30 mg de rituximab intralesional, tres veces a la semana, una vez al mes, durante 4 meses, con respuesta completa. Realizamos una revisión de los casos de linfoma cutáneo de células B tratados con rituximab intralesional (AU)

Cutaneous follicular center B-cell lymphomas are indolent tumors characterized by the presence of neoplastic follicular center cells. They contain a mixture of centrocytes with a variable number of centroblasts. The tumor is usually treated by surgery or radiotherapy, although other treatments may be used such as interferon-a, chemotherapy, and biological agents (rituximab). Rituximab is a chimeric monoclonal anti-CD20 antibody that can be administered intravenously or intralesionally. We report the case of a 41-year-old man who consulted for violaceous nodular lesions in the left scapular region and who was diagnosed with cutaneous follicular center B-cell lymphoma after biopsy, laboratory tests, thoracic-abdominal-pelvic computed tomography, abdominal ultrasound, and bone marrow biopsy. It was decided to treat him with 30 mg of intralesional rituximab administered for 1 week (3 times) every month for 4 months. Complete response was obtained. We also review the published cases of cutaneous B-cell lymphoma treated with intralesional rituximab (AU)

[Cutaneous follicular center B-cell lymphoma treated with intralesional rituximab]. / Linfoma cutáneo de células B del centro folicular tratado con rituximab intralesional.

Cutaneous follicular center B-cell lymphomas are indolent tumors characterized by the presence of neoplastic follicular center cells. They contain a mixture of centrocytes with a variable number of centroblasts. The tumor is usually treated by surgery or radiotherapy, although other treatments may be used such as interferon-alpha, chemotherapy, and biological agents (rituximab). Rituximab is a chimeric monoclonal anti-CD20 antibody that can be administered intravenously or intralesionally. We report the case of a 41-year-old man who consulted for violaceous nodular lesions in the left scapular region and who was diagnosed with cutaneous follicular center B-cell lymphoma after biopsy, laboratory tests, thoracic-abdominal-pelvic computed tomography, abdominal ultrasound, and bone marrow biopsy. It was decided to treat him with 30 mg of intralesional rituximab administered for 1 week (3 times) every month for 4 months. Complete response was obtained. We also review the published cases of cutaneous B-cell lymphoma treated with intralesional rituximab.

[Cutaneous adverse reaction to Bio-Alcamid implant]. / Reacción cutánea tras implante con Bio-Alcamid.

In the last years new and numerous materials for the correction of defects and wrinkles have been developed. One of these materials is Bio-Alcamid, a non reabsorbable gel polymer constituted by meshes of poly-alkyl-imide, without known adverse effects. We report a 34-year-old woman that had Bio-Alcamid implants for acne scars and several months after presented nodular lesions together with a painful inflammatory nodule. The nodule was drained and culture of the purulent material yielded Streptococcus viridans. A cytology and a cellular block of that material showed a granulomatous inflammatory reaction together with a foreign body. The different types of reactions to implants and their pathogenic mechanism are discussed. It is important to know these possible reactions to filler materials given their increasing use and the potential medico-legal consequences.