Elena Gallego

Effect of time to sentinel-node biopsy on the prognosis of cutaneous melanoma.

INTRODUCTION In patients with primary cutaneous melanoma, there is generally a delay between excisional biopsy of the primary tumour and sentinel-node biopsy. The objective of this study is to analyse the prognostic implications of this delay. PATIENTS AND METHOD This was an observational, retrospective, cohort study in four tertiary referral hospitals. A total of 1963 patients were included. The factor of interest was the interval between the date of the excisional biopsy of the primary melanoma and the date of the sentinel-node biopsy (delay time) in the prognosis. The primary outcome was melanoma-specific survival and disease-free survival. RESULTS A delay time of 40 days or less (hazard ratio (HR), 1.7; confidence interval (CI), 1.2-2.5) increased Breslow thickness (Breslow ⩾ 2 mm, HR, > 3.7; CI, 1.4-10.7), ulceration (HR, 1.6; CI, 1.1-2.3), sentinel-node metastasis (HR, 2.9; CI, 1.9-4.2), and primary melanoma localised in the head or neck were independently associated with worse melanoma-specific survival (all P < 0.03). The stratified analysis showed that the effect of delay time was at the expense of the patients with a negative sentinel-node biopsy and without regression. CONCLUSION Early sentinel-node biopsy is associated with worse survival in patients with cutaneous melanoma.

Factores predictivos del estado del ganglio centinela en el melanoma cutáneo: análisis mediante un árbol de clasificación y regresión

OBJECTIVE The main aim of this study was to identify predictors of sentinel lymph node (SN) metastasis in cutaneous melanoma. PATIENTS AND METHODS This was a retrospective cohort study of 818 patients in 2 tertiary-level hospitals. The primary outcome variable was SN involvement. Independent predictors were identified using multiple logistic regression and a classification and regression tree (CART) analysis. RESULTS Ulceration, tumor thickness, and a high mitotic rate (≥6 mitoses/mm(2)) were independently associated with SN metastasis in the multiple regression analysis. The most important predictor in the CART analysis was Breslow thickness. Absence of an inflammatory infiltrate, patient age, and tumor location were predictive of SN metastasis in patients with tumors thicker than 2mm. In the case of thinner melanomas, the predictors were mitotic rate (>6 mitoses/mm(2)), presence of ulceration, and tumor thickness. Patient age, mitotic rate, and tumor thickness and location were predictive of survival. CONCLUSIONS A high mitotic rate predicts a higher risk of SN involvement and worse survival. CART analysis improves the prediction of regional metastasis, resulting in better clinical management of melanoma patients. It may also help select suitable candidates for inclusion in clinical trials.

Gemcitabine therapy-associated cutaneous vasculitis with a polyarteritis nodosa-like pattern

1 Cohen PR, Grossman ME, Silvers DN, Kurzrock R. Tripe palms and cancer. Clin Dermatol 1993; 11: 165–173. 2 Moore RL, Devere TS. Epidermal manifestations of internal malignancy. Dermatol Clin 2008; 26: 17–29. 3 Cohen PR, Kurzrock R. Malignancy-associated tripe palms. J Am Acad Dermatol 1992; 27: 271–272. 4 Mullans EA, Cohen PR. Tripe palms: a cutaneous paraneoplastic syndrome. South Med J 1996; 89: 626–627. 5 Khaled A, Abdallah MB, Tekaya R, et al. Tripe palms with oligoarthritis, two rare paraneoplastic syndromes heralding a small cell lung cancer. J Eur Acad Dermatol Venereol 2009; 23: 579–580.

Role of vascular endothelial growth factor C in classical Hodgkin lymphoma.

Abstract We performed three different studies to obtain additional data on the biological and prognostic role of vascular endothelial growth factor C (VEGFC) in classical Hodgkin lymphoma (cHL): (1) serum VEGFC levels were measured by enzyme-linked immunosorbent assay in 80 patients; (2) immunohistochemical VEGFC expression in tumor tissue was evaluated using a case–control study in 62 patients; (3) gene expression of VEGFC was investigated in vitro in six cHL cell lines, and was compared with expression in inflammatory lymph nodes. Higher serum VEGFC levels were found in patients with cHL than in healthy volunteers (median, 7675 vs. 1358 pg/mL, p < 0.001) and high VEGFC expression in tissue predicted worse progression-free survival at 7 years (41% vs. 91%, p < 0.0001). VEGFC expression in all Hodgkin lymphoma cell lines was higher than the mean expression level in inflammatory lymph nodes. Our data suggest that Hodgkin and Reed–Sternberg cells produce VEGFC, and VEGFC expression could be a novel prognostic factor in cHL.

Human immunodeficiency virus (HIV)-associated eosinophilic folliculitis and follicular mucinosis in a black woman.

Our patient is a 35-year-old woman from Nigeria but living in Spain for a year, HIV diagnosed for 5 months, and had a 4-month history of a pruritic papular recurrent eruption, distributed mainly on the face and thorax. The eruption first appeared on the head as pruritic pustules and gradually progressed to involve the neck, upper chest, and back (Fig. 1a–b). At the time of consultation she was receiving emtricitrabina, tenofovir, lopinavir, and ritonavir; her CD4 count was 300 cells/mm and plasma HIV RNA of 48145 copies/ml. There was no history of previous medication. Hematological, biochemical, immunological, and urine analysis were within normal limits. Histopathologic examination of two biopsies obtained from the back and from the forehead showed similar findings. There was a prominent superficial and deep mixed inflammatory infiltrate with numerous eosinophils and follicular eosinophilic spongiosis. Pustulosis involving the infundibular region of the hair follicle was observed. The infiltrate extends into the sebaceous glands (Fig. 2a). The epidermis was eroded and covered by a scale crust. Striking feature was the follicular deposit of mucinous material stained positive with alcian blue at pH 2.5 and colloidal iron (Fig. 2b). A Gram and PAS stain showed no microorganisms. Microbiological examination and culture of swabs from pustules revealed no bacteria or fungi. Based on the clinical and histological findings, a diagnosis of HIV-associated eosinophilic folliculitis (HIV-EF) with follicular mucinosis (FM) was made. The patient was treated with oral antihistamines, minociclina (100 mg/d) and topical corticosteroid. All lesions had resolved by the time of her 3-month follow-up evaluation; the patient is now under narrow band UVB therapy for mild pruritus just on the trunk. Eosinophilic folliculitis as a clinical entity is a heterogeneous group of disorders that broadly fall into three main forms, namely, Ofuji’s disease, HIV-EF and eosinophilic folliculitis of infancy. HIV-EF is a pruritic, follicular eruption that typically develops in the setting of abnormal 1308

Sarcoma epitelioide. Un tumor de difícil diagnóstico

Resumen —El sarcoma epitelioide es un tumor poco frecuente de evolucion lenta y diagnostico dificil en fases iniciales, pero con gran tendencia a recidivar y elevada capacidad metastatizante. Se presenta un varon de 27 anos con una tumoracion aparecida sobre la cicatriz de la extirpacion, 2 anos antes, de una lesion diagnosticada como fascitis nodular seudosarcomatosa en el antebrazo derecho. El diagnostico de sarcoma epitelioide requirio dos biopsias y el tumor recidivo a los 6 meses de la escision amplia de la lesion.

Is mitotic rate still useful in the management of patients with thin melanoma

T1 melanoma substaging was recently modified by the American Joint Committee on Cancer (AJCC). Although sentinel lymph node (SLN) positivity is the most important prognostic factor in melanoma, there is a lack of consensus on whether SLN biopsy should be performed in patients with thin melanoma (≤1 mm).

Treatment of actinic cheilitis with methyl aminolevulinate photodynamic therapy and light fractionation: a prospective study of 10 patients

Actinic cheilitis (AC) is a common disorder of the lower lip caused by chronic ultraviolet radiation exposure and smoking. Numerous studies have reported good clinical and histologic response in patients with AC treated with photodynamic therapy (PDT) with 5-aminolevulinic acid and its methyl ester, methyl aminolevulinate (MAL) [1-4]. Described treatment schemes require several sessions held on different days but fractionated illumination, with 2 light doses delivered in the same day, which is described [...]