O. Sanmartín

Mohs micrographic surgery in dermatofibrosarcoma protuberans allows tumour clearance with smaller margins and greater preservation of healthy tissue compared with conventional surgery: a study of 74 primary cases

Dermatofibrosarcoma protuberans (DFSP) is an uncommon skin tumour with aggressive local growth. Whether DFSP should be treated with conventional surgery (CS) or Mohs micrographic surgery (MMS) has long been a topic of debate.

Skin involvement as the first manifestation of breast implant-associated anaplastic large cell lymphoma.

Breast implant‐associated anaplastic large cell lymphoma (ALCL) is a newly described clinical and pathologic entity that typically presents as seroma in the fibrous scar around the implant. Less frequently, it presents as a solid peri‐implant mass, and there have been no reports to date of cutaneous lesions as the presenting manifestation.

Sunitinib-induced pseudoporphyria.

References 1 Hyman AB, Harris H, Brownstein MH. Eccrine angiomatous hamartoma. N Y State J Med 1968; 68: 2803–2806. 2 Aloi F, Tomasini C, Pippione M. Eccrine angiomatous hamartoma: a multiple variant. Dermatology 1992; 184: 219–222. 3 Morell DS, Ghalli FE, Stahr BJ, McCauliffe DP. Eccrine angiomatous hamartoma: a report of symmetric and painful lesions of the wrist. Pediatr Dermatol 2001; 18: 117–119. 4 Sugimoto Y, Araki E, Inoguchi N et al. Adult-onset multiple eccrine angiomatous hamartoma in enlarging hairy plaques. Acta Derm Venereol 2007; 87: 180–181. 5 Domonkos AN, Suarez LS. Sudoriparous angioma. Arch Dermatol 1967; 96: 552–553. 6 Martinelli PT, Tschen JA. Eccrine angiomatous hamartoma: a case report and review of the literature. Cutis 2003; 71: 449–455. 7 Sanmartin O, Botella R, Alegre V, Martinez A, Aliaga A. Congenital eccrine angiomatous hamartoma. Am J Dermatopathol 1992; 14: 161– 164. 8 Zeller DJ, Goldman RL. Eccrine-pilar angiomatous hamartoma: a report of a unique case. Dermatologica 1971; 143: 100–104. 9 Donati P, Amantea A, Balus L. Eccrine angiomatous hamartoma: a lipomatous variant. J Cutan Pathol 1989; 16: 227–229. 10 Larralde M, Bazzolo E, Boggio P, Abad ME, Santos Mu~ noz A. Eccrine angiomatous hamartoma: report of five congenital cases. Pediatr Dermatol 2009; 26: 316–319. 11 Kopera D, Soyer HP, Kerl H. Human eccrine hamartoma of the forearm-antebrachial organ of the ringtailed lemur (Lemur catta). A possible phylogenetic relationship? Am J Dermatopathol 1994; 16: 275–279.

Adverse reaction to silicone simulating orofacial granulomatosis.

Granulomatous reactions to silicone facial fillers are well described in the literature. Clinically, these reactions present as nodules or pseudotumors that are frequently described as silicone granulomas or siliconomas.

Skin necrosis as a predictive factor for neoplasia in dermatomyositis

Dermatomyositis (DM) is a rare myopathic disorder characterized by symmetric proximal muscle weakness and characteristic skin lesions; it is associated with an underlying neoplasm in up to 30% of cases.1-7 Several studies have recently been aimed at identifying demographic, clinical, and laboratory data that could predict the individual risk of malignant tumors in patients with DM. Several authors agree in considering the appearance of necrotic skin lesions as a potential risk factor for paraneoplastic DM. We report the case of a 58-year-old man who came to our department with a 2-month history of symmetric muscle weakness associated with multiple erythematouspurpuric papules over the interphalangeal joints of both hands (Gottron papules) and asymptomatic edematous violaceous plaques (heliotrope rash) (Figure 1A). Other skin findings were periungual telangiectasia and hypertrophy of the nail cuticle Figure 1B). The most relevant clinical finding consisted of extensive areas of slightly painful skin necrosis in a symmetrical distribution over the upper third of the thorax and back (Figure 1C). Histology showed an atrophic epidermis, mild interface dermatitis with vacuolar degeneration of the basement membrane, and a superficial perivascular lymphocytic inflammatory infiltrate accompanied by interstitial deposits of mucin. Laboratory findings, with elevated levels of muscle enzymes (creatine phosphokinase, 5280 U/L) and aldolase (47.5 U/mg) were compatible with a diagnosis of DM.

Biosynthetic Porcine Collagen Dressings as an Adjunct or Definitive Tool for the Closure of Scalp Defects Without Periosteum

BACKGROUND Aggressive carcinomas of the scalp usually occur in elderly patients with multiple comorbidities. Complete excision of this type of tumor often involves the removal of periosteum, and the resulting defects can be difficult to reconstruct. OBJECTIVE To evaluate the usefulness of porcine type I collagen dressings as adjunct or definitive treatment in the surgical closure of scalp defects without periosteum. MATERIALS AND METHODS We performed a prospective study between January 2009 and November 2011 of patients with scalp defects larger than 5cm resulting from surgery that required the removal of periosteum to obtain tumor-free margins. RESULTS The most prevalent type of tumor was recurrent cutaneous squamous cell carcinoma. The surgical defects ranged in diameter from 5 to 7cm. In 100% of the patients who received a graft after dressing removal (n=4), the graft took well. In the patients in whom the biosynthetic dressing was definitive (n=6), granulation tissue filled the defect and complete closure was achieved in approximately 3.5 months. CONCLUSIONS The use of porcine type I collagen dressings as an adjunct or definitive tool for the closure of surgical defects on the scalp measuring more than 5cm in which periosteum has been removed proved to be simple, inexpensive, and effective.

Parche biosintético de colágeno porcino como herramienta coadyuvante o definitiva en el cierre de defectos del cuero cabelludo sin periostio

BACKGROUND: Aggressive carcinomas of the scalp usually occur in elderly patients with multiple comorbidities. Complete excision of this type of tumor often involves the removal of periosteum, and the resulting defects can be difficult to reconstruct. OBJECTIVE: To evaluate the usefulness of porcine type I collagen dressings as adjunct or definitive treatment in the surgical closure of scalp defects without periosteum. MATERIALS AND METHODS: We performed a prospective study between January 2009 and November 2011 of patients with scalp defects larger than 5cm resulting from surgery that required the removal of periosteum to obtain tumor-free margins. RESULTS: The most prevalent type of tumor was recurrent cutaneous squamous cell carcinoma. The surgical defects ranged in diameter from 5 to 7cm. In 100% of the patients who received a graft after dressing removal (n=4), the graft took well. In the patients in whom the biosynthetic dressing was definitive (n=6), granulation tissue filled the defect and complete closure was achieved in approximately 3.5 months. CONCLUSIONS: The use of porcine type I collagen dressings as an adjunct or definitive tool for the closure of surgical defects on the scalp measuring more than 5cm in which periosteum has been removed proved to be simple, inexpensive, and effective.

A randomized intraindividual comparative study of methyl-5-aminolaevulinate vs. 5-aminolaevulinic acid nanoemulsion (BF-200 ALA) in photodynamic therapy for actinic keratosis of the face and scalp

We designed a prospective, randomized, intraindividual, investigator-blinded clinical trial comparing methyl-5-aminolaevulinate (MAL) cream and 5-aminolaevulinic acid nanoemulsion (BF-200 ALA) in the treatment of actinic keratosis (AK) with photodynamic therapy (PDT). Eligible patients had to have two symmetric, comparable areas of skin (left and right) containing at least eight non-hypertrophic AK lesions on the face or scalp.1 The study was approved by the ethics committee at the Instituto Valenciano de Oncología and written informed consent was obtained from all participants. This article is protected by copyright. All rights reserved.