Depósito Académico
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- Double subcutaneous island pedicle flap for reconstruction of large upper and central chin defects(John Wiley & Sons, 2024) Gómez Arias, P. (Pedro); Salido-Vallejo, R. (Rafael); Antoñanzas-Perez, J. (Javier); Aguado, L. (Leyre)Chin reconstruction poses a significant task for dermatologic surgeons due to its unique contour and shape, as well as the fact that it features the thickest skin on the face, resulting in typically poorer scarring in this area compared to other facial locations.There are numerous reconstructive options employed for the closure of oncological surgical defects in the chin region, ranging from advancement, transposition or rotation flaps to much more complex choices like free flaps. We present a case of a surgical defect in the midportion of the chin successfully reconstructed using a double island advancement flap.
- Generalized pustulosis following Covid 19 vaccination in a patient in treatment with adalimumab(Wiley, 2024) Estenaga, Á. (Ángela); Morelló-Vicente, A. (Ana); Mitxelena, J. (Josune); Antoñanzas-Perez, J. (Javier); Laíño-Piñeiro, M. (M.); Aguado, L. (Leyre); Oteiza-Rius, I. (Inés)Dear Editors, Adalimumab is a tumor necrosis factor (TNF)-α inhibitor commonly used for multiple autoimmune diseases. Paradoxical cutaneous reactions under anti-TNF-α drugs have been described in the literature, predominantly linked to adalimumab.1 Although this adverse effect is widely known, mechanisms underlying its induction, as well as possible risk factors, are still unknown. Here we report a case of papulopustular psoriasis induced by a second dose of Covid vaccine in a patient treated with adalimumab. The patient was a 52-year-old woman with history of HLA B27(–) spondylarthritis. No personal or family history of psoriasis was reported. During the previous 9 months she had been in treatment with adalimumab (40 mg) subcutaneously every 2 weeks. No other treatment was initiated during this period. However, she had received the second Covid vaccine the previous week (1st dose: Janssen, 2nd dose: Moderna). The patient presented with an abruptly developed generalized papulopustular reaction that had initiated as a palmoplantar pustulosis (Figure 1). A biopsy was performed and revealed generalized pustulosis (Figure 2). Adalimumab was discontinued and daily topical application of clobetasol propionate 0.05% plus urea 20% resulted in progressive improvement of the lesions. However, although clinical improvement was noted after the use of topical corticosteroids, the patient did not present with complete remission of the lesions.
- Effectiveness of neoadjuvant intralesional methotrexate in cutaneous squamous cell carcinoma: A prospective cohorts study(Wiley-Blackwell, 2022) Nieto-Benito, L.M. (Lula M.); Bergón-Sendín, M. (Marta); Díez-Sebastián, J. (Jesús); Pulido-Pérez, A. (Ana); Suárez-Fernández, R. (Ricardo); Barchino-Ortiz, L. (Lucía)Intralesional methotrexate (il-MTX) has been used in cutaneous squamous cell carcinoma (cSCC) achieving important reductions in tumor size. However, there is a lack of controlled studies on this regard. The primary objective was to analyze the effect of il-MTX on tumor size in cSCC. As a secondary objective, we evaluated its impact on the surgical approach. We conducted a prospective cohorts study that included 200 patients with histologically confirmed cSCC. Patients in Group 1 (Cases) received neoadjuvant treatment with il-MTX prior to surgery. Patients in Group 2 (Controls) underwent scheduled surgery without prior neoadjuvant therapy. Clinical measurements of lesions were made at the time of inclusion in the study and before surgery. No intergroup statistical differences were found between the assessed variables. In Group 1, tumor size reduction occurred in 93% of the patients after il-MTX therapy. Tumor surface was reduced by 54%. Complex reconstructions were needed in 15% of these patients. In Group 2, tumor surface increased by 33.1% and complex reconstructions were needed in 40% of patients. Intergroup differences were statistically significant (p < 0.001). Neoadjuvant Il-MTX therapy achieves very important tumor size reduction and significantly simplifies surgical treatment.
- Surgical outcomes and psychosocial impact of giant congenital melanocytic nevus surgery: A single-center case series of 136 patients(Elsevier, 2021) López-Gutiérrez, J.C. (Juan Carlos); Tomás-Velázquez, A. (Alejandra); Ceballos-Rodríguez, C. (Carmen); Cieza-Díaz, D. (Deysy); Redondo-Bellón, P. (Pedro)Purpose: The aim of this study was to evaluate the outcomes, complications and psychosocial impact of surgical treatment of giant congenital melanocytic nevus (GCMN). Methods: Patients with surgically treated GCMN who attended our clinic between May 2014 and May 2018 were included. Patient demographics and data on the characteristics of the nevus, surgical treatment, and the psychosocial impact (including C-DLQI/DLQI questionnaires) were collected. Results: One hundred thirty-six patients were included (median age 9 years). Mean age at first surgery was 34 (+/- 61.45) months; 5.53 (+/- 3.69) surgical interventions were necessary to completely excise the nevus. The expanded skin flap was the preferred surgical technique in most locations. Complications were common but not severe. Of the patients studied, 70.4% reported that the surgery had a minor impact on their quality of life (QoL). Patients and caregivers stated that surgical treatment should begin as soon as possible, even in cases where early treatment did not have an impact on their QoL nor on their satisfaction with the surgery (p < 0.05). The lower the patient age at first surgery, the higher the surgeon's satisfaction (p < 0.01). Conclusions: Surgical treatment is a safe option for management of GCMN, and has a low impact on QoL. Patients, caregivers, and surgeons agree that the treatment should begin as soon as possible. This is the largest single-center study evaluating surgical treatment in GCMN patients and its psychosocial impact, and the first to take into account the patient, caregivers and dermatologists opinion of surgical results.
- Dermoscopy of cutaneous melanoma metastasis: a color-based pattern classification(Wiley-Blackwell, 2019) Sánchez-Herrero, A. (Alejandro); Aviles-Izquierdo, J.A. (José Antonio); Nieto-Benito, L.M. (Lula M.); Rodríguez-Lomba, E. (Enrique); Mateos-Mayo, A. (Ana); Ciudad-Blanco, C. (Cristina)Dermoscopic studies about cutaneous metastases of malignant melanoma (CMMM) are few. Our objective was to analyze the dermoscopic features of CMMM and propose a new dermoscopic pattern classification based on color pigmentation and some specific dermoscopic features. A retrospective evaluation of 150 dermoscopic images of CMMM taken from 40 patients was performed. One hundred CMMM images were individually evaluated by six dermatologists in order to classify them according to four dermoscopic patterns: (i) blue pattern; (ii) pink pattern; (iii) brown pattern; and (iv) mixed pattern. One hundred and fifty dermoscopic images including 50 CMMM and 100 benign lesions were evaluated by five dermatologists to calculate the accuracy of these patterns in the recognition of CMMM. An intra- and interobserver reproducibility agreement study between all different dermoscopic pattern classifications was performed. Seventy-five percent of our cases of CMMM showed a monochromatic pattern. Light brown pigmented halo, peripheral gray spots and polymorphic atypical vessels were the most significant focal dermoscopic structures. The reproducibility of the color-based dermoscopic pattern classification was superior to previous dermoscopic pattern classification. In summary, a dermoscopic pattern classification based on color pigmentation and some specific dermoscopic features may be useful in recognizing early cutaneous melanoma metastasis. Multicentric studies are recommended in order to lower the impact of interobserver variability.
- 'Rainbow pattern': a dermoscopic sign of invasive melanoma(Oxford Academics, 2021-11-10) Nieto-Benito, L.M. (Lula M.); Hernández-de-la-Torre, E. (E.); Rodríguez-Lomba, E. (Enrique); Lozano-Masdemont, B. (B.); Parra-Blanco, V. (Verónica); Suárez-Fernández, R. (Ricardo); García-Piqueras, P. (P.)Background: The 'rainbow pattern' was initially described as a highly specific dermoscopic feature of Kaposi sarcoma. Since then, it has been reported in many benign and malignant cutaneous tumours, including a few malignant melanomas (MMs). Aim: To determine the frequency and presentation of this dermoscopic pattern in primary cutaneous MMs in comparison to other cutaneous tumours. Methods: The presence of a rainbow pattern was evaluated in a sample of 1100 dermoscopic images of different melanocytic and nonmelanocytic cutaneous neoplasms. Results: The rainbow pattern was observed in 23 of 245 (9.4%) MM and 44 of 855 (5.1%) non-MM neoplasms. MMs presenting this feature were generally thicker: 82.6% > 1 mm and 43.0% > 2 mm. Compared with non-MMs, rainbow pattern in MMs was more commonly focal (82.7% vs. 36.4% nonfocal, P = 0.001) and associated with > 2 dermoscopic structures associated with MM (100% vs. 9% with fewer, P = 0.001). Conclusion: The rainbow pattern is a dermoscopic sign that can occasionally be observed in invasive MMs. In MMs, this feature is usually associated with other dermoscopic criteria of MM and located in a focal and eccentric area, as opposed to a diffuse and isolated presentation in non-MM neoplasms.
- Clinical response to ustekinumab in CARD14-associated papulosquamous eruption (CAPE) with a new missense mutation in CARD14: a case report and systematic review(Wiley, 2020) Campos-Domínguez, M. (M.); Nieto-Benito, L.M. (Lula M.); Torrelo, A. (Antonio); Moreno, A. (A.); Hernandez, A. (A.); Baniandrés-Rodríguez, O. (O.)The term CAPE was first introduced by Craiglow et al.1 to define a papulosquamous eruption due to mutations in CARD14 in patients who display characteristics of both psoriasis and pityriasis rubra pilaris (PRP). Heterozygous mutations in CARD14 have been described in psoriasis2 and PRP3, 4 patients, indicating that these disorders share a common underlying pathophysiology.
- Histological findings after intralesional methotrexate treatment in cutaneous squamous cell carcinoma(Wiley, 2020) Nieto-Benito, L.M. (Lula M.); Bergón-Sendín, M. (Marta); Parra-Blanco, V. (Verónica); Pulido-Pérez, A. (Ana); Suárez-Fernández, R. (Ricardo); Rosell-Díaz, A.M. (Ángel Manuel)Intralesional methotrexate (il-MTX) has been reported as a useful therapy in keratoacanthoma (KA) and cutaneous squamous cell carcinoma (cSCC). However, the data available on the histological changes induced by this therapy are very scarce. We conducted a single center, prospective study that included 65 cases of cSCC treated with il-MTX before surgical treatment. Two histological studies were conducted in all patients: before intralesional treatment and after surgical removal. Lesions were assessed longitudinally both clinically and histologically. 60 patients (92.3%) responded to il-MTX treatment. There were no differences regarding aggressive histological features of the cSCC between responder and non-responder patients. All cases showed a chronic inflammatory infiltrate after il-MTX. Intratumoral necrosis areas were frequently observed. All cases showed local fibrosis with fine thickening of collagen bundles. Il-MTX induces a chronic lymphohistiocytic inflammatory reaction in both clinical responder and nonresponder patients. Tumor involution after il-MTX is followed by a fine fibrosis that explains the great cosmetic results and improves the accuracy of the follow-up.
- Aprepitant in refractory pruritus of systemic lymphoproliferative disorders(Wiley, 2020) Bastos-Oreiro, M.B. (M.B.); Romero-Jimenez, R. (R.); Nieto-Benito, L.M. (Lula M.); Bergón-Sendín, M. (Marta); Dorado-Herrero, N. (N.); Pulido-Pérez, A. (Ana); Suárez-Fernández, R. (Ricardo); Lopez, A. (A.)araneoplastic pruritus represents a frequent symptom in the debut or progression of lymphoproliferative disorders. It affects approximately 30% of patients with Hodgkin lymphoma and 15% of patients with non-Hodgkin lymphoma.1 Aprepitant has shown promising results in the treatment of refractory pruritus of primary cutaneous T-cell lymphomas (CTCL).
- Cocaine-induced pyoderma gangrenosum-like lesions(Wiley, 2018) Tomás-Velázquez, A. (Alejandra); Moreno, E. (Esther); España, A. (Agustín); Gil-Sanchez, M.P. (María Pilar); Rodríguez-Garijo, N. (Nuria); Idoate, M.A. (Miguel Ángel); Querol-Cisneros, E. (Elena)Cocaine consumption is increasing at an alarming rate. This drug produces euphoria, anorexia, increased alertness and diminished sleep requirements. It is estimated that up to 80 % of cocaine is contaminated with levamisole, a substance which may potentiate the drug’s chemical effects [ 1 ] . Multiple mucocutaneous manifestations have been associated with cocaine use [ 2 ] , including cocaine-induced pyoderma gangre-nosum (CIPG), cocaine-induced midline destructive lesions (CIMDL) and retiform purpura (RP). We present three cases of cocaine abuse with skin lesions compatible with PG, and review the epidemiological, clinical, histopathological and immunological characteristics of CIPG and RP. We suggest that these two conditions are more closely related than previously thought. Additionally, in our opinion, no specific immunological or histological profile would be indicative of levamisole toxicity.
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