J.J. Ríos-Martín

Effect of Teledermatology on the Prognosis of Patients With Cutaneous Melanoma

OBJECTIVE To evaluate differences in the initial prognosis of patients with cutaneous melanoma managed by teledermatology (TD) vs other non-TD referral systems. DESIGN Descriptive and longitudinal study of a store-and-forward TD system aimed at the triage of patients with suspicious pigmented lesions. SETTING In 2003, a store-and-forward TD triage system aimed at the selection of patients with skin growths suggestive of cancer was implemented at a skin cancer clinic. This system has been shown to be accurate and reliable and able to significantly shorten waiting periods for consultation with a dermatologist. PARTICIPANTS Patients with primary cutaneous melanoma referred to the Melanoma Clinic of the Dermatology Unit, Hospital Universitario Virgen Macarena, Seville, Spain, by TD or non-TD tracks were included in the study. MAIN OUTCOME MEASURES Decisions on the referral of patients with suspicious skin lesions by store-and-forward TD vs by a conventional referral system. Breslow thickness and tumor stage were recorded in each study group (TD and non-TD) and were compared. RESULTS Two hundred one patients with primary cutaneous melanoma were enrolled in the study. In total, 33.3% were managed at their primary care center by teleconsultation, whereas 66.7% were managed by a conventional referral system. The mean Breslow thickness was significantly lower among patients in the TD group than among patients in the non-TD group (1.06 vs 1.64 mm, P = .03). The frequency of melanoma with a favorable initial prognosis (tumor stages Tis and T1a) was significantly higher in the TD group (70.1% vs 56.9%, P = .03). The odds ratio of having a cutaneous melanoma with a favorable initial prognosis in the TD group was 1.96 (95% CI, 1.14-3.50; P = .04). CONCLUSION Teledermatology as a screening system for cutaneous melanoma has a favorable effect on the initial prognosis of patients with melanoma.

Granular cell atypical fibroxanthoma: report of two cases.

Two cases of an uncommon histopathological variant of atypical fibroxanthoma (AFX) are described. Even though both lesions presented as clinically conventional atypical fibroxanthoma, histopathology disclosed a neoplasm composed of cells with granular change that was negative for S100 staining, and showed prominent pleomorphism, severe nuclear atypia, and a high mitotic index. Degenerative change may explain the granular phenotype in these two cases of AFX. The differential diagnosis with primitive nonneural granular cell tumor is discussed.

Cutaneous pseudolymphoma in association with molluscum contagiosum in an elderly patient

Background:  Molluscum contagiosum (MC) is a common cutaneous infection, which has been reported in association with cutaneous pseudolymphoma in few cases.

Localized Kaposi's sarcoma in a patient with pemphigus vulgaris

We report the case of a patient with a 13‐year history of pemphigus vulgaris (PV) treated with immunosuppressive agents, prednisone and mycophenolate mofetil who had developed lesions of Kaposis sarcoma (KS) on a sole plaque of PV that had been previously treated with intralesional injections of steroids. The lesions were surgically removed and polymerase chain reaction (PCR) demonstrated human herpesvirus‐8 (HHV‐8) DNA. There were neither recurrences nor later dissemination of KS following gradual decrease of the immunosuppressive therapy. We suggest that the treatment with intralesional steroids may have influenced the local reactivation of a latent infection of the virus, determining the appearance of this localized KS.

Sarcomatoid Carcinoma of the Skin: Report of a Case

We report the histological, immunohistochemical and ultrastructural findings of an exophytic cutaneous tumor composed of a mixture of typical basal cell carcinoma (BCC) and malignant fibrous histiocytoma. Nine previously reported carcinosarcomas of the skin are reviewed. We prefer the term “sarcomatoid carcinoma” for this rare neoplasm. Only the BCC showed a positive immunoreaction to cytokeratin; the sarcomatous component was negative, but it did express vimentin, and, focally, smooth‐muscle‐specific actin and KP1 (CD68). Both components showed p53 immunostaining.

Intra- and Inter-Tumoral Homogeneity of BRAFV600E Mutations in Melanoma Tumors

The era of targeted therapy has introduced a new therapeutic perspective for melanoma patients. Treatment with BRAFV600 inhibitors has improved overall and disease-free survival in metastatic melanoma patients whose tumors harbor BRAFV600 mutations. Although the BRAFV600E mutation appears to have a critical role in tumor initiation, its expression during tumor progression remains controversial. In fact, various authors claim that BRAFV600E heterogeneity is evident in melanoma tumors. Herein, we investigated the pattern of BRAFV600E expression in matched primary and metastatic samples from 140 patients. Using a combination of real-time PCR and immunohistochemical analyses, we demonstrated that BRAFV600E expression is homogeneous in melanoma tumors and hypothesized that the heterogeneity described by others might be attributable to technical issues when molecular methods are used. We also demonstrated the high efficiency of the anti-BRAFV600E VE1 antibody for the detection of BRAFV600E mutations in melanoma tumors.

Basal cell carcinoma with sarcomatoid features (sarcomatoid carcinoma): report of a case and review of the literature.

We report a new case of sarcomatoid carcinoma, which showed cellular features of basal cell carcinoma and malignant fibrous myxoid histiocytoma. For this new case and rare neoplasm, we propose the designation of sarcomatoid basal cell carcinoma, as both components were intimately intermingled, the spindle cells seemed to arise from epithelial cells, and both tumoral components showed the same immunohistochemistry expression, cytokeratin and P53 protein, suggesting a monoclonal origin. The epithelial component, a basal cell carcinoma, may have been the first component in the carcinogenesis process.

Three Cases of Bullous Pemphigoid Associated with Dipeptidyl Peptidase-4 Inhibitors - One due to Linagliptin

Background: Bullous pemphigoid (BP) is an acquired subepidermal autoimmune blistering disease in which there are humoral and cellular responses against the BP180 and BP230 antigens. Dipeptidyl peptidase (DPP)-4 inhibitors enhance endogenous glucagon peptide-1 and glucose-dependent insulinotropic polypeptide secretion with food intake, which leads to insulin secretion, as well as to the reduction of glucagon secretion. Recently, several cases of DPP-4 inhibitor-associated BP have been reported. Objectives: To report 3 cases of DPP-4 inhibitor-associated BP, one of which is due to linagliptin use, as well as to review all currently published cases of DPP-4 inhibitor-associated BP. Case Reports: Three patients diagnosed with BP at our department showed a clear temporal relationship between the introduction of DPP-4 for the treatment of diabetes and the onset of BP. One case was due to linagliptin use, while the other 2 cases were due to an association with vildagliptin-metformin use. Conclusions: This is the first report of linagliptin-associated BP. Furthermore, 2 other cases of vildagliptin-associated BP are reported.

Aproximación al diagnóstico dermatopatológico de las lesiones figuradas

Both clinical and pathologic findings must be considered when diagnosing figurate skin lesions, which are often seen in routine practice. Although a skin biopsy may sometimes be diagnostic, more often the information provided is nonspecific. In an attempt to offer an approach to diagnosing these dermatoses, we have classified annular lesions according to the presence of lymphocytic, neutrophilic-eosinophilic, or granulomatous infiltrates, and infiltrates containing plasma cells. Neoplastic annular lesions are included in a separate group. Lesions containing lymphocytic infiltrates include superficial and deep erythema annulare centrifugum and the differential diagnosis includes a large number of conditions. In the neutrophilic-eosinophilic class, we include annular psoriasis, vasculitis, linear immunoglobulin A dermatosis, eosinophilic dermatitis, erythema marginatum rheumatica, and annular erythema of infancy. Sarcoidosis and granuloma annulare are the prototypical annular lesions containing granulomas. Secondary syphilis is typical of lesions containing plasma cells. Mycosis fungoides is the principal skin tumor that may initially manifest with annular lesions.

Fine needle aspiration cytology of an acral myxoinflammatory fibroblastic sarcoma: case report with cytological and cytogenetic findings.

A 29-year-old man presented with a slow-growing, painless mass on the third finger of the left hand. This began as a distal swelling but later progressed towards the palm, eventually affecting the whole finger. The patient underwent surgery to drain abundant mucoid material; the initial surgical diagnosis was a large ganglion cyst. One month later, the patient consulted because of a new swelling affecting the distal twothirds of the finger (Figure 1). Fine needle aspiration was performed. What is your diagnosis? Acral myxoinflammatory fibroblastic sarcoma (AMIFS) is the most recent form of fibrosarcoma to be reported so far. It is considered to be a unique lowgrade sarcoma with myxoid stroma, inflammatory infiltrate and virocyte-like cells (WHO) that may readily be confused with inflammatory processes, such as pigmented villonodular tenosynovitis, or various reactive fibroinflammatory processes. One of its distinctive features is a preference for the hands and feet, but it has also been reported in more proximal areas, such as the forearm, upper arm, thigh and even the neck. Its clinical, histological, inmunohistochemical and ultrastructural features have been well documented in several series, but few reports are available on fine needle aspiration (FNA) cytology findings. Cytogenetic reports are also scarce. Two reports describing complex karyotypes present different findings: a reciprocal translocation between chromosomes 1 and 10 t(1;10)(p22;q24) with loss of chromosomes 3 and 13, as against supernumerary ring chromosomes and a derivative chromosome 13, with additional material on the short arm. This paper reports on the cytological and cytogenetic findings in a recurrent AMIFS on the third finger of the left hand of a young adult.