Tomás-Velázquez, A. (Alejandra)
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- Serum levels of S-100 protein are directly proportional to the size, number, thickness and degree of cellularity of congenital melanocytic nevi(Elsevier, 2023) López-Gutiérrez, J.C. (Juan Carlos); Tomás-Velázquez, A. (Alejandra); Andrés, E.M. (Eva M.); Reyes, M. (Miguel); Salgado, C.M. (Claudia M.); Ceballos-Rodríguez, C. (Carmen); Triana, P. (Paloma); Hervas-Stubbs, S. (Sandra); Reina, G. (Gabriel); Andrea, C.E. (Carlos Eduardo) de; Basu, D. (Dipanjan); Redondo-Bellón, P. (Pedro)To the Editor: Some patients with congenital melanocytic nevi (CMN) present progressive growth and thickening, extracutaneous involvement (neurocutaneous melanocytosis, NCM) or neoplastic transformation (melanoma); and others remain stable or even regress. There are no markers to assess progression or follow-up. Recently, we found S-100, a protein which acts on cell differentiation and proliferation, elevated in CMN.1 S-100 is a ligand of the RAGE pathway (related to the MAPK-pathway), and low serum levels of soluble-RAGE were related to poor survival in melanoma.2 Also SOX10, expressed in melanocytes with high specificity, is useful in detection, prognosis and treatment assessment of melanoma.3 We explored if S-100, RAGE and SOX10 serum levels vary in children’s CMN and assessed clinical or pathological correlations.
- 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.
- Acute parvovirus B19 infection: Analysis of 46 patients(Elsevier, 2020) Tomás-Velázquez, A. (Alejandra); Estenaga, Á. (Ángela); España, A. (Agustín); Escribano, A. (Ángela); Rodríguez-Garijo, N. (Nuria); Reina, G. (Gabriel)Introduction: Parvovirus B19 (PVB19) infection has a high incidence and worldwide distribution. It has a broad clinical spectrum, with skin, joint and haematological manifestations being the most common. The objective of this study was to determine the epidemiology and clinical–analytical manifestations of acute PVB19 infection. Patients and methods: A retrospective study of patients with a positive IgM serology for PVB19 (10 years). Forty-six patients were included and their demographic, clinical and analytical characteristics were analyzed. Results: Primary infection was most prevalent in women (ratio 2.2:1) aged 41 (mean age). Joint involvement was the most common manifestation (65%). Skin abnormalities were observed in more than half of patients (24 cases): rash (28%), megalerythema (9%), “gloves and socks” involvement (6.5%), periflexural rash (4%) and oedema (4%). Anaemia was the main haematological alteration (35%). The symptoms were self-limiting and resolved in 1–2 weeks in most patients. Conclusions: Although there is a variable clinical spectrum, polyarthralgias and generalized maculopapular rash with fever and anaemia are the typical and most frequent manifestations of primary infection by PVB19 and are usually self-limiting.
- Alpelisib decreases nevocytes of congenital melanocytic nevi(Elsevier, 2023) López-Gutiérrez, J.C. (Juan Carlos); Tomás-Velázquez, A. (Alejandra); Reyes-Múgica, M. (Miguel); Salgado, C.M. (Claudia M.); Andrea, C.E. (Carlos Eduardo) de; Redondo-Bellón, P. (Pedro)Background: Multiple, large or giant congenital melanocytic nevi (CMN) are uncommon and affected patients can show progressive growth and thickening, associate neurocutaneous melanocytosis or develop melanoma. Current treatment modalities are mostly complex surgeries that frequently do not solve the disease and its risks completely. Thus, investigation on new treatment options for CMN and its complications must continue. MAPK pathway inhibitors are being investigated, also targeting PI3K-AKT. Omipalisib (PI3K inhibitor, with no indications approved yet) has been studied for CMN in vitro and in mice with promising results. However, alpelisib, a PI3K inhibitor approved with an adequate safety profile for patients with severe manifestations of PROS (PIK3CA-Related Overgrowth Spectrum), had not yet been tested for CMN. Objective: To evaluate the effect of alpelisib in nevocytes of congenital melanocytic nevi. Methods: Nevomelanocytic tissue samples of 10 patients were collected prospectively and, following a previously reported preclinical ex vivo model, explants were placed in organotypic culture for 5 days, with or without alpelisib. Consecutively, tissue sections were stained and using scanned images with Qupath and ImageJ softwares, representative regions from the dermis were analysed (using Wilcoxon test and Spearman's correlation). Results: When comparing alpelisib-treated explants with respect to control explants, we found a decrease in cell density (p = 0.0273), in density of SOX10+ -cells (p = 0.0391) and also in the % of S-100+ area (p = 0.0078), in alpelisib samples. The three markers showed a positive correlation (p < 0.05). Conclusions: This study provides first-time evidence that alpelisib induces nevocyte reduction in CMN from patient-derived explants, probably inducted by autophagy. Alpelisib is an approved drug with an adequate safety profile used in another mosaicism affecting PI3K (PROS). Further studies are needed to evaluate its efficacy in treating CMN and potentially, their complications, either with local or systemic administration, alone or in combination.
- Popper’s Dermatitis: An Unusual Diagnostic Challenge(Wiley, 2021) Tomás-Velázquez, A. (Alejandra); Estenaga, Á. (Ángela); Gil-Sanchez, M.P. (María Pilar); Rodríguez-Garijo, N. (Nuria); Antoñanzas-Perez, J. (Javier); Aguado, L. (Leyre)Volatile nitrites, and especially isobutyl nitrite or “Popper”, are popular drugs of abuse in Europe, mainly in men that have sex with men (MSM). Inhalation is the most common route of consumption, but direct contact with skin or muco- sal membranes has been associated with a local adverse event called “Popper’s dermatitis”. To date, just five cases have been reported, most of them on the face, but also on other parts of the body [1, 2].
- Assessment of frontalis myocutaneous transposition flap for forehead reconstruction after Mohs surgery(American Medical Association, 2018) Tomás-Velázquez, A. (Alejandra); Redondo-Bellón, P. (Pedro)Importance: Forehead reconstruction after Mohs surgery has become a challenge for dermatology surgeons, and achieving an excellent cosmetic and functional result is imperative in this location. Objective: To highlight the utility of a frontalis myocutaneous transposition flap (FMTF) for forehead reconstruction after Mohs surgery. Design, setting, and participants: Surgical technique case series including 12 patients with large forehead defects recruited between January 2010 and June 2017 at the Dermatology Department of the University Clinic of Navarra, Spain. All patients underwent Mohs micrographic surgery for skin cancer (5 basal cell carcinomas, 4 melanomas, 2 squamous cell carcinomas, and 1 adnexal tumor) located on the forehead (8 paramedian, 2 midline, and 2 lateral subunits) resulting in defects ranging from 9 to 28 cm2 in size. Intervention: Mohs micrographic surgery followed by FMTF. Taking into account the defect's size and location, a lateral lobulated flap is designed with an inferior pedicle and incision lines are made vertically to the hairline containing part of the frontalis muscle or its fascia. The flap swings into the primary defect and direct closure of the donor site is achieved. Additional corrections for removing skin folds or a guitar-string suture can be made. Main outcomes and measures: Absence of acute complications and achievement of high aesthetic and functional goals in postoperative follow-up. Results: Satisfactory cosmetic and functional results were achieved for all 12 patients (7 men and 5 women; mean age, 62.7 years [range, 47-86 years]) and there were no postoperative complications. All the myocutaneous flaps survived without any acute complications, such as episodes of local bleeding, infection, flap margin necrosis, or congestion. Postoperative follow-up ranged from 6 months to 3 years. No patient needed scar revision. Six patients presented with paresthesia in areas of the forehead and scalp. Sensory recovery tended to improve over time, and paresthesia gradually decreased, disappearing in 5 of 6 cases after 12 months. In 3 patients there was a minimal hair transposition that required laser treatment. Conclusions and relevance: The FMTF provides a simple method for 1-stage reconstruction of large forehead defects as an alternative to classic advancement flaps.
- Chronic rhinosinusitis is associated with prolonged SARS-CoV-2 RNA shedding in upper respiratory tract samples: A case-control study(Ponte Editora, Sociedade Unipessoal, Lda., 2021) Seijo, L. (Luis); Landecho, M.F. (Manuel F.); Campo, A. (Arantza); Tomás-Velázquez, A. (Alejandra); Satrustegui-Alzugaray, B. (Blanca); Rodríguez-Mateos, M. (Mariano); Marín-Oto, M. (Marta); Fernández-Alonso, M. (Miriam); Felgueroso, C. (Carmen); Recalde-Zamacona, B. (Borja); Bertó, J. (Juan); Alcaide, A.B. (Ana Belén); Iñigo, M. (Melania); Madeleine-Di-Frisco, I. (I.); Zulueta, J. (Javier)Abstract. Recalde-Zamacona B, Tomas-Vel azquez A, Campo A, Satrustegui-Alzugaray B, Fern andez- Alonso M, Inigo M, Rodr ~ ıguez-Mateos M, Di Frisco M, Felgueroso C, Berto J, Mar ın-Oto M, Alcaide AB, Zulueta JJ, Seijo L, Landecho MF (Clinica Universidad de Navarra; Health Center of San Juan, Pamplona, Spain). Chronic rhinosinusitis is associated with prolonged SARS-CoV-2 RNA shedding in upper respiratory tract samples: A case-control study. J Intern Med 2021; 289: 921– 925. https://doi.org/10.1111/joim.13237 Background. SARS-CoV-2, the COVID-19 causative agent, has infected millions of people and killed over 1.6 million worldwide. A small percentage of cases persist with prolonged positive RT-PCR on nasopharyngeal swabs. The aim of this study was to determine risk factors for prolonged viral shedding amongst patient’s basal clinical conditions. Methods. We have evaluated all 513 patients attended in our hospital between 1 March and 1 July. We have selected all 18 patients with pro- longed viral shedding and compared them with 36 sex-matched randomly selected controls. Demo- graphic, treatment and clinical data were system- atically collected. Results. Global median duration of viral clearance was 25.5 days (n = 54; IQR, 22–39.3 days), 48.5 days in cases (IQR 38.7–54.9 days) and 23 days in controls (IQR 20.2–25.7), respectively. There were not observed differences in demographic, symptoms or treatment data between groups.Chronic rhinosi- nusitis and atopy were more common in patients with prolonged viral shedding (67%) compared with controls (11% and 25% respectively) (P < 0.001 and P = 0.003). The use of inhaled corticosteroids was also more frequent in case group (P = 0.007). Mul- tivariate analysis indicated that CRS (odds ratio [OR], 18.78; 95% confidence interval [95%CI], 3.89– 90.59; P < 0.001) was independently associated with prolonged SARS-CoV-2 RNA shedding in URT samples, after adjusting for initial PCR Ct values. Conclusion. We found that chronic rhinosinusitis and atopy might be associated with increased risk of prolonged viral shedding. If confirmed in prospec- tive trials, this finding might have clinical implica- tions for quarantine duration due to increased risk of pandemic spread.
- Simplified lower eyelid reconstruction algorithm after basal cell carcinoma surgery: A retrospective series of patients(Elsevier, 2023) Tomás-Velázquez, A. (Alejandra); Salido-Vallejo, R. (Rafael); Barrio-Barrio, J. (Jesús); Redondo-Bellón, P. (Pedro)The lower eyelid is a frequent location for basal cell carcinoma (BCC), and oncoplastic reconstruction usually represents a challenge for the dermatologic surgeon. To create a useful and practical algorithm for lower eyelid reconstruction, a retrospective chart review of patients with lower eyelid BCC treated with surgery between 2015 and 2020 at the dermatology department of University Clinic of Navarra in Spain was performed. Defects were classified into three categories based on the vertical component: pretarsal, preseptal and complex (pretarsal + preseptal)1 (Table 1). Patients with BCC on the eyelid-cheek junction (n = 4), patients with BCC extended to both eyelids (n = 3) and patients with extensive posterior lamella defects that required a particular reconstruction of the lamella (n = 5) were excluded.
- 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.
- Neoadjuvant intralesional methotrexate for juvenile xanthogranuloma in an adult(Wiley, 2021) Tomás-Velázquez, A. (Alejandra); Estenaga, Á. (Ángela); Reyes-Múgica, M. (Miguel); Morelló-Vicente, A. (Ana); Salido-Vallejo, R. (Rafael); Antoñanzas-Perez, J. (Javier); González-Menchen, A. (Alberto)Juvenile xanthogranuloma (JXG) is a non-Langerhans cell histiocytosis usually occurring in infants and typically located in the head or neck.1 Clinically, solitary skin lesions are found in 60%–82% of patients and the most common variant is characterized by one yellowish nodule. Adult onset is rare, and although JXG is usually self-limiting in children, spontaneous resolution is uncommon at older ages. In addition, up to 50% of patients with spontaneous regression develop an atrophy or anetodermal area.2 Thus, complete excision is frequently performed in this population subgroup to achieve better cosmetic results. In disseminated forms, different chemotherapy regimens, corticosteroids and other systemic therapies are used. Herein, we report a case of adult JXG treated with intralesional methotrexate (MTX) resulting in a rapid reduction in size.