Risk of a Second Skin Cancer in a Cohort of Patients With Nonmelanoma Skin Cancer -Basal Cell Carcinoma or Squamous Cell Carcinoma-Treated With Mohs Micrographic Surgery: A National Prospective Cohort Study. / Riesgo de aparición de segundas neoplasias cutáneas en una cohorte de pacientes diagnosticados de carcinoma queratinocítico (carcinoma basocelular y carcinoma epidermoide) tratados con cirugía de Mohs. Estudio de cohortes prospectivo nacional.

OBJECTIVE: Patients with nonmelanoma skin cancer (NMSC)-ie, basal cell carcinoma (BCC) or squamous cell carcinoma (SCC)-have an increased risk of developing a second skin cancer. The aim of this study was to describe the frequency, incidence per 1000 person-years, and predictors of a second skin cancer in a cohort of patients with NMSC treated with Mohs micrographic surgery (MMS). MATERIAL AND METHODS: Prospective study of a national cohort of patients with NMSC who underwent MMS at 22 Spanish hospitals between July 2013 and February 2020; case data were recorded in the REGESMOHS registry. The study variables included demographic characteristics, frequency and incidence per 1000 person-years of second skin cancers diagnosed during the study period, and risk factors identified using mixed-effects logistic regression. RESULTS: We analyzed data for 4768 patients who underwent MMS; 4397 (92%) had BCC and 371 (8%) had SCC. Mean follow-up was 2.4 years. Overall, 1201 patients (25%) developed a second skin cancer during follow-up; 1013 of the tumors were BCCs (21%), 154 were SCCs (3%), and 20 were melanomas (0.4%). The incidence was 107 per 1000 person-years (95% CI, 101-113) for any cancer, 90 per 1000 person-years (95% CI, 85-96) for BCC, 14 (95% CI, 12-16) per 1000 person-years for SCC, and 2 (95% CI, 1-3) per 1000 person-years for melanoma. More men than women developed a subsequent skin cancer (738 [61%] vs 463 [39%]). The main risk factors were a history of multiple tumors before diagnosis (relative risk [RR], 4.6; 95% CI, 2.9-7.1), immunosuppression (RR, 2.1; 95% CI, 1.4-3.1), and male sex (RR, 1.6; 95% CI, 1.4-1.9). CONCLUSION: Patients have an increased risk of developing a second tumor after MMS treatment of NMSC. Risk factors are a history of multiple tumors at diagnosis, immunosuppression, and male sex.

Mohs micrographic surgery in the elderly: comparison of tumours, surgery and first-year follow-up in patients younger and older than 80 years old in REGESMOHS.

BACKGROUND: The elderly population is increasing and more patients in this group undergo Mohs micrographic surgery (MMS). The few publications investigating MMS in elderly people conclude that it is a safe procedure; however, these are single-centre studies without a comparison group. OBJECTIVE: To compare the characteristics of patients, tumours, MMS and 1-year follow-up in patients younger than 80 years, with patients older than 80 years at the time of surgery. METHODS: Data was analysed from REGESMOHS, a prospective cohort study of patients treated with MMS. The participating centres were 19 Spanish hospitals where at least one MMS is performed per week. Data on characteristics of the patient, tumour and surgery were recorded. Follow-up data were collected from two visits; the first within 1 month postsurgery and the second within the first year. RESULTS: From July 2013 to October 2016, 2575 patients that underwent MMS were included in the registry. Of them, 1942 (75.4%) were aged <80 years and 633 (24.6%) were ≥80 years old. In the elderly, the tumour size was significantly higher with a higher proportion of squamous cell carcinoma. Regarding surgery, elderly more commonly had tumours with deeper invasion and required a higher number of Mohs surgery stages, leaving larger defects and requiring more time in the operating room. Despite this, the incidence of postoperative complications was the same in both groups (7%) and there were no significant differences in proportion of relapses in the first-year follow-up. CONCLUSION: The risk of short-term complications and relapses were similar in elderly and younger groups. MMS is a safe procedure in the elderly.

Retroniquia: estudio ecográfico y tratamiento quirúrgico de un caso / Retronychia: A Case Report Including Ultrasound Imaging and Surgical Treatment

La retroniquia es un proceso emergente en el que la parte proximal de la lámina ungueal se encarna en el pliegue ungueal proximal, produciendo una paroniquia crónica refractaria a terapias antimicrobianas. La ecografía se ha postulado como la prueba no invasiva de confirmación y para diagnóstico diferencial, sobre todo con afecciones tumorales y artríticas locales. La presencia de dos o más láminas ungueales superpuestas y la disminución de la distancia entre el origen de la lámina ungueal y la base de la falange distal podrían ser los criterios ecográficos distintivos de esta entidad. La avulsión quirúrgica de la lámina ungueal es la terapia de elección y curativa de la misma. Su conocimiento todavía está poco difundido entre los dermatólogos, ocasionando errores y demoras diagnósticas y terapéuticas, lo que nos ha motivado a la presentación de un nuevo caso

Retronychia is a recently described disorder caused by ingrowth of the proximal nail plate into the proximal nail fold. This situation provokes chronic paronychia refractory to antimicrobial therapy. Ultrasound has been proposed as the noninvasive method of choice to confirm the diagnosis and rule out other differential diagnoses, particularly local tumors and arthritic disease. The presence of 2 or more overlapping nail plates and a reduced distance between the root of the nail plate and the base of the distal phalanx could be the ultrasound hallmarks of this condition. Nail plate avulsion is the treatment of choice and is curative. Knowledge of retronychia is still limited among dermatologists, which can lead to diagnostic and therapeutic errors and delay. This has prompted us to present this new case

Retronychia: A Case Report Including Ultrasound Imaging and Surgical Treatment. / Retroniquia: estudio ecográfico y tratamiento quirúrgico de un caso.

Retronychia is a recently described disorder caused by ingrowth of the proximal nail plate into the proximal nail fold. This situation provokes chronic paronychia refractory to antimicrobial therapy. Ultrasound has been proposed as the noninvasive method of choice to confirm the diagnosis and rule out other differential diagnoses, particularly local tumors and arthritic disease. The presence of 2 or more overlapping nail plates and a reduced distance between the root of the nail plate and the base of the distal phalanx could be the ultrasound hallmarks of this condition. Nail plate avulsion is the treatment of choice and is curative. Knowledge of retronychia is still limited among dermatologists, which can lead to diagnostic and therapeutic errors and delay. This has prompted us to present this new case.

Réplica a «Estudio retrospectivo de 49 casos de infección aguda por parvovirus B19 en adultos» / Response to ‘‘Acute Parvovirus B19 Infection in Adults: A Retrospective Study of 49 Cases’’

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Estudio retrospectivo de 49 casos de infección aguda por parvovirus B19 en adultos / Acute Parvovirus B19 Infection in Adults: A Retrospective Study of 49 Cases

Objetivo: El objeto de nuestro trabajo es describir las características epidemiológicas, clínicas y analíticas de la infección aguda por parvovirus B19 en adultos. Material y métodos: Presentamos un estudio descriptivo retrospectivo de todos los casos de infección aguda por parvovirus B19, en mayores de 18 años, durante el año 2012, en el Hospital Universitario La Paz, Madrid. Resultados: Cuarenta y nueve pacientes adultos con infección aguda por parvovirus B19. La mayoría ocurrieron en mujeres jóvenes en primavera y principios de verano. La lesión cutánea fue el signo fundamental para el diagnóstico en más del 50% de los casos. Se encontraron todo tipo de exantemas purpúricos más o menos generalizados, siendo relativamente frecuente la forma de vasculitis (> 18%). Las alteraciones en el hemograma y perfil hepático, leves o moderadas, se resolvieron espontáneamente, salvo en 2 pacientes inmunodeprimidos en quienes persistió una anemia crónica. Conclusiones: Es la serie más amplia de infección aguda por parvovirus B19 descrita, hasta la fecha, en la literatura. Ante exantemas purpúricos de cualquier distribución o lesiones de vasculitis, sobre todo si se acompanan de fiebre y artralgias y se presentan en mujeres jóvenes en primavera, debemos sospechar una infección aguda por parvovirus B19 y recomendar medidas para evitar el contagio a personas de riesgo (AU)

Objective: Our aim was to describe the epidemiologic, clinical, and laboratory characteristics of acute parvovirus B19 infection in adults. Material and methods: This study describes all cases of acute parvovirus B19 infection in patients older than 18 years of age who were treated at Hospital Universitario La Paz in Madrid, Spain, in 2012. Results: Forty-nine adults were treated for acute parvovirus B19 infection. Most were young women who were infected in the spring or early summer. In over half the cases skin lesions were key diagnostic signs.We saw the full range of types of rash of purplish exanthems that were fairly generalized; vasculitis was relatively common (in > 18%). Mild or moderate abnormalities in blood counts and indicators of liver dysfunction resolved spontaneously in all but 2 immunocompromised patients, who developed chronic anemia. Conclusions: This is the largest case series of acute parvovirus B19 infection published to date. This infection should be suspected on observing signs of purplish skin rashes, no matter the location or pattern of distribution, or vasculitis, especially if accompanied by fever and joint pain in young women in the spring. Measures to avoid infection should be recommended to individuals at risk (AU)

Acute parvovirus B19 infection in adults: a retrospective study of 49 cases.

OBJECTIVE: Our aim was to describe the epidemiologic, clinical, and laboratory characteristics of acute parvovirus B19 infection in adults. MATERIAL AND METHODS: This study describes all cases of acute parvovirus B19 infection in patients older than 18 years of age who were treated at Hospital Universitario La Paz in Madrid, Spain, in 2012. RESULTS: Forty-nine adults were treated for acute parvovirus B19 infection. Most were young women who were infected in the spring or early summer. In over half the cases skin lesions were key diagnostic signs.We saw the full range of types of rash of purplish exanthems that were fairly generalized; vasculitis was relatively common (in >18%). Mild or moderate abnormalities in blood counts and indicators of liver dysfunction resolved spontaneously in all but 2 immunocompromised patients, who developed chronic anemia. CONCLUSIONS: This is the largest case series of acute parvovirus B19 infection published to date. This infection should be suspected on observing signs of purplish skin rashes, no matter the location or pattern of distribution, or vasculitis, especially if accompanied by fever and joint pain in young women in the spring. Measures to avoid infection should be recommended to individuals at risk.

[Clinical-pathological features of cutaneous melanomas diagnosed in a Mediterranean tertiary hospital between 1990 and 2004: a comparison between sexes and age groups and analysis of longterm outcomes]. / Características clínicopatológicas de los melanomas cutáneos diagnosticados en un hospital terciario mediterráneo entre 1990 y 2004: comparación entre sexos, por grupos de edad y evolución a lo largo del tiempo.

BACKGROUND: The incidence of malignant melanoma has increased over recent decades. Early diagnosis continues to be essential for effective treatment. Our objective was to analyze cutaneous malignant melanomas diagnosed over a 15-year period in a tertiary hospital for trends towards earlier diagnosis and to identify subgroups with poorer prognosis. MATERIAL AND METHODS: Retrospective analysis of primary cutaneous melanomas analyzed in the pathology department of Hospital La Paz, Madrid, Spain, between 1990 and 2004. RESULTS: In total, 526 melanomas were diagnosed. The mean (SD) Breslow thickness was 2.63 (4.84) mm and the median thickness was 0.98 mm (range, 0-65 mm). The mean size (widest point) was 16.59 (12.11) mm. The most common histological type was surface-spreading melanoma and the most common site was the trunk. Melanomas detected in men were generally larger and thicker than in women (P=0.05). Individuals aged over 60 years consulted for significantly thicker and larger tumors than younger individuals. The incidence of malignant melanomas has increased steadily over the years whereas the mean Breslow thickness and size have decreased. CONCLUSIONS: Diagnosis of melanoma in Spain is made increasingly earlier, although locally advanced tumors are still sometimes seen in men and in individuals aged over 60 years.

Características-patológicas de los melanomas cutáneos diagnosticados en un hospital terciario mediterráneo entre 1990 y 2004: comparación entre sexos, por grupos de edad y evolución a lo largo del tiempo / Clinical&-Pathological Features of Cutaneous Melanomas Diagnosed in a Mediterranean Tertiary Hospital Between 1990 and 2004: A Comparison Between Sexes and Age Groups and Analysis of Long‑term Outcomes

Introducción. En las últimas décadas está aumentando la incidencia de melanoma maligno (MM) y el diagnóstico precoz sigue siendo esencial para conseguir su curación. Nuestro objetivo fue analizar los MM cutáneos diagnosticados durante 15 años en un hospital terciario para comprobar si existe una tendencia favorable hacia un diagnóstico cada vez más precoz e intentar identificar grupos de población con MM de peor pronóstico. Material y métodos. Análisis retrospectivo de los melanomas cutáneos primarios analizados en el Departamento de Anatomía Patológica del Hospital La Paz entre 1990 y 2004. Resultados. Se diagnosticaron en total 526 melanomas. El espesor medio de Breslow fue de 2,63 mm (desviación estándar [DE] 4,84) y la mediana de 0,98 mm (0-65 mm); el tamaño medio (diámetro mayor) fue de 16,59 mm (DE 12,11); el tipo histológico más frecuente fue el melanoma de extensión superficial y la localización más habitual el tronco. Los melanomas detectados en varones tendieron a ser más grandes y de mayor espesor (p = 0,05) que los de las mujeres. Los mayores de 60 años consultaron con tumores significativamente más gruesos y de mayor diámetro que los pacientes más jóvenes. A lo largo de estos años, ha aumentado progresivamente el número de MM, pero han disminuido el Breslow medio y el tamaño. Conclusiones. El diagnóstico del melanoma en nuestro medio es cada vez más precoz, pero los varones y los mayores de 60 años en ocasiones aún consultan con tumores localmente avanzados (AU)

Background. The incidence of malignant melanoma has increased over recent decades. Early diagnosis continues to be essential for effective treatment. Our objective was to analyze cutaneous malignant melanomas diagnosed over a 15-year period in a tertiary hospital for trends towards earlier diagnosis and to identify subgroups with poorer prognosis. Material and methods. Retrospective analysis of primary cutaneous melanomas analyzed in the pathology department of Hospital La Paz, Madrid, Spain, between 1990 and 2004. Results. In total, 526 melanomas were diagnosed. The mean (SD) Breslow thickness was 2.63 (4.84) mm and the median thickness was 0.98 mm (range, 0-65 mm). The mean size (widest point) was 16.59 (12.11) mm. The most common histological type was surface-spreading melanoma and the most common site was the trunk. Melanomas detected in men were generally larger and thicker than in women (P = 0.05). Individuals aged over 60 years consulted for significantly thicker and larger tumors than younger individuals. The incidence of malignant melanomas has increased steadily over the years whereas the mean Breslow thickness and size have decreased. Conclusions. Diagnosis of melanoma in Spain is made increasingly earlier, although locally advanced tumors are still sometimes seen in men and in individuals aged over 60 years (AU)

[Genital autoaggression. An unusual presentation]. / Autoagresión genital. Una forma de presentación poco habitual.

Self-injuries are relatively common and usually consist in incisive injuries on the penis and the scrotum. This paper presents one case of genital self-injury by injection of petrol on the back of the penis. A description is offered of the clinical form of presentation, as well as the good evolution following medical treatment. Finally, a revision of likely complications is included.