Hugo Vázquez-Veiga

Male genital leiomyomas showing androgen receptor expression

Genital leiomyoma in men include those superficial leiomyomas arising in the scrotum and the areola. They are unusual neoplasms: few cases have been reported in the literature and they usually escape clinical diagnosis. Three cases of male genital leiomyomas are reported: two in the scrotum and one in the areola. They were all conservatively excised and the behaviour was completely benign in all cases. Histopathological examination showed the typical findings of superficial leiomyomas, with some minor differences between cases arising in the scrotum and those from the areola. Immunohistochemical findings not only confirmed the smooth muscle nature of all cases but also showed unequivocal immunostaining for androgen receptors in the leiomyomas from the scrotum. Immunostaining for androgen receptors in scrotal leiomyomas is, as far as we are aware, a previously unknown characteristic of male genital leiomyomas. This finding supports the role of steroid hormones in the growth of genital leiomyomas, similar to leiomyomas found in other locations.

Vemurafenib-Induced Neutrophilic Panniculitis: A New Case and Review of the Literature.

Vemurafenib has proved to be useful in the treatment of patients with unresectable or metastatic melanoma harboring the BRAF-V600E mutation, with better rates of overall and progression-free survival than previous treatments. Adverse cutaneous effects, such as alopecia, pruritus, photosensitivity reactions, verrucous keratosis, keratoacanthomas, or squamous cell carcinomas, have been described. Thirty cases of vemurafenib-associated panniculitis are available in the literature with variable clinical relevance. Only 9 of them exhibited definitive evidence of neutrophilic panniculitis. They all consist of multiple lesions, usually located in the lower limbs. Histopathologically, they have been described as predominantly neutrophilic, lymphocytic, or mixed, more commonly with lobular location. We report an additional case of neutrophilic panniculitis in a 45-year-old woman treated with vemurafenib for metastatic melanoma, presenting as a single lesion on his right leg. The lesion resolved spontaneously and did not need treatment reduction. The presentation of this condition with a single lesion is particularly challenging. Recognition of this association is important given the increasing use of vemurafenib and the potential implications of treatment withdrawal.

Descripción de los pacientes intervenidos mediante cirugía de Mohs en España. Datos basales del registro español de cirugía de Mohs (REGESMOHS)

INTRODUCTION The Spanish registry of Mohs micrographic surgery started collecting data in July 2013. The aim of the registry is to report on the use of this technique in Spain and the outcomes achieved. In the present article, we describe the characteristics of patients and the tumors treated. MATERIAL AND METHODS This is a prospective cohort study of patients treated with Mohs micrographic surgery. The participating centers are hospitals where at least one intervention of this type is performed each week. All patients considered for Mohs micrographic surgery in participating centers are included in the registry except those who have been declared legally incompetent. RESULTS Between July 2013 and October 2014, data from 655 patients were included in the registry. The most common tumor involved was basal cell carcinoma, and the most common histological subtype was infiltrative basal cell carcinoma. Most of the tumors treated were located on the face or scalp, and the most common site was the nose. Almost 40% of the tumors treated were recurrent or persistent, and preoperative tumor size was similar to that reported in other European studies and in Australia. In total, 45.5% of patients had received previous surgical treatment. CONCLUSION The findings are similar to those reported in other studies, and the data collected are useful for assessing whether the results of studies carried out elsewhere are applicable in Spain.

Persisting allergic patch test reaction to minoxidil manifested as cutaneous lymphoid hyperplasia.

Keywords: allergic contact dermatitis; cutaneous lymphoid hyperplasia; minoxidil; patch test; persisting reaction

Descripción de las intervenciones quirúrgicas recogidas en el registro español de cirugía de Mohs (REGESMOHS) (2013-2015)

INTRODUCTION The Spanish Mohs Surgery Registry is used to collect data on the use and outcomes of Mohs micrographic surgery (MMS) in Spain. The aim of this study was to describe perioperative and intraoperative data recorded for MMS procedures performed between July 2013 (when the registry started) and January 2016. MATERIAL AND METHODS Prospective cohort study of data from 18 hospitals. The data collected included type of anesthesia, surgical technique, hospital admission, number of Mohs stages, management of preoperative risk factors, additional treatments, previous treatments, type of tumor, operating time, and complications. RESULTS Data were available for 1796 operations. The most common tumor treated by MMS was basal cell carcinoma (85.96%), followed by squamous cell carcinoma (6.18%), lentigo maligna (2.81%), and dermatofibrosarcoma protuberans (1.97%). Primary tumors accounted for 66.9% of all tumors operated on; 19.2% of tumors were recurrent and 13.9% were persistent. The most common previous treatment was surgical. MMS was mostly performed under local anesthesia (86.7% of cases) and as an outpatient procedure (71.8%). The frozen section technique was used in 89.5% of cases. One stage was needed to achieve tumor-free margins in 56.45% of patients; 2 stages were required in 32.1% of patients, 3 in 7.1%%, 4 in 2.7%, and 5 or more in 1.8%. The defect was reconstructed by the dermatologist in 98% of patients and the most common technique was flap closure (47.2%). Intraoperative complications were recorded for just 1.62% of patients and the median (interquartile range) duration of surgery was 75 (60-100) minutes. CONCLUSION The characteristics of the patients and tumors treated by MMS are similar to those reported for similar studies in other geographic areas. Lentigo maligna and dermatofibrosarcoma protuberans accounted for a higher proportion of cases in our series, and repair of the surgical defect by a dermatologist was also more common. Operating times in MMS are not much longer than those reported for other procedures and the rate of intraoperative complications is very low.

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

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.

Skin ultrasound is a useful tool for evaluating and monitoring eosinophilic fasciitis

cutaneous lesions relapsed 1 month after the prednisolone withdrawal, they went into remission with use of topical clobetasol propionate. Dyshidrosiform pemphigoid is generally classified into two types. In the first type, vesiculobullous lesions initially develop on the palmoplantar areas and later spread to other parts of the body. In the second type, vesiculobullous lesions localize on the palms and/or soles throughout the course of disease. Although most reported cases are of the former type, our case was of the latter type, and the patient showed bullae localized to the soles. We presumed that mechanical stress to the soles and a lack of hair follicles in the soles together lead to blister formation only on the soles. We speculate below on the causal mechanisms of the intraepidermal bullae in our case. The anatomical characteristics of abundant sweat ducts and thick epidermis might lead to quick reepithelization at the bottom of blisters, resulting in the unique histopathological appearance in the present case. Indeed, intraepidermal bullae can be seen frequently in pemphigoid and most likely represents the feature of an older (i.e., healing/re-epithelializing) blister. The present patient had neither apparent coagulopathy nor hemorrhage due to a trauma in the lesional sites. Thus, the cause of the purpuric nature of the lesions is still unknown, although hemorrhagic lesions were also reported in a case of DP in the literature. We speculate that the purpuric nature could be due to minor trauma associated with ambulation and the body weight load. In the present DP patient, her skin lesions were restricted to the soles throughout the disease course. Our case further suggests that localized DP is a distinct clinical entity of BP.

Differences of Mohs micrographic surgery in basal cell carcinoma versus squamous cell carcinoma

The two main tumors treated with Mohs micrographic surgery (MMS) are basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). There are no studies analyzing whether MMS is different when treating these two types of tumors.

Cutaneous acute graft‐versus‐host disease with isomorphic disposition over striae distensae in a 12‐year‐old girl

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Vulvar and areolar melanosis: a case report and review of the literature

Vulvar and areolar melanoses are benign pigmented lesions that may clinically resemble melanoma. While melanoma of the vulva merely constitutes 1–3 % of all melanomas, vulvar melanosis represents 60 % of pigmented vulvar lesions. On the other hand, areolar melanoma is exceptional, and only 13 cases of areolar melanosis have been reported [1–7]. A 35-year-old woman (skin phototype III) was referred to our dermatology department with a five-year history of asymptomatic pigmented lesions on her left breast; similar lesions on her vulva had been present for six months. While there was no past medical history with regard to pregnancy or breast surgery, she had undergone surgery for ovarian mucinous cystadenoma two years earlier. There was no family history of similar pigmented lesions. Dermatological examination showed heterochromic pigmented macules with sharply demarcated but irregular borders, involving the labia minora and the inner aspect of the labia majora. Moreover, there were multiple mucosa-colored, translucent, nontender papules in the vulvar vestibule (Figure 1a). On dermatoscopy, the labia majora showed a combined pattern of predominantly structureless areas and ring-like structures (Figure 1b). Dermatoscopy of the labia minora revealed a pigmented, structureless pattern on a papillomatous surface (Figure 1c). On the left areola, she presented irregular, hyperpigmented lesions intermingled with hypopigmented areas (Figure 2a). Here, dermatoscopy demonstrated a reticular pattern, with a honeycomb appearance and ring-like structures, against a cobblestone-like background (Figure 2b). Histopathological examination of both breast as well as genital lesions revealed slight epidermal acanthosis with basal hyperpigmentation. Immunohistochemical staining for S-100 protein, HMB-45, and Melan-A revealed mild melanocytic hyperplasia. The papillary dermis showed isolated melanophages; atypical features were not observed (Figure 1d–e, 2c–d). The patient was diagnosed with vulvar melanosis associated with vestibular papillomatosis and melanosis of the nipple. There were no lesional changes over the course of a ten-month follow-up. Vulvar melanosis, a common benign condition of unknown pathogenesis, occurs most commonly in perimenopausal women. In a retrospective study, four distinct dermatoscopic