Garnacho-Saucedo, G.M. (Gloria Maria)
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- Risk of Second Primary Malignancies in Melanoma Survivors: A Population-Based Study(MDPI, 2023) Morelló-Vicente, A. (Ana); Salido-Vallejo, R. (Rafael); Antoñanzas-Perez, J. (Javier); Aguado, L. (Leyre); Redondo-Bellón, P. (Pedro); Garnacho-Saucedo, G.M. (Gloria Maria)(1) Introduction: The association between melanoma (MM) and the occurrence of second primary neoplasms (SPNs) has been extensively studied, with reported incidence rates ranging from 1.5% to 20%. This study aims to evaluate the occurrence of SPNs in patients with a history of primary MM and to describe the factors that make the risk higher in our population. (2) Material and Methods: We conducted a prospective cohort study and calculated the incidence rates and relative risks (RR) for the development of different SPNs in 529 MM survivors from 1 January 2005 to 1 August 2021. Survival and mortality rates were obtained, and the Cox proportional hazards model was used to determine the demographic and MM-related factors that influence the overall risk. (3) Results: Among the 529 patients included, 89 were diagnosed with SPNs (29 prior to MM diagnosis, 11 synchronous, and 49 after MM), resulting in 62 skin tumors and 37 solid organ tumors. The estimated probability of developing SPNs after MM diagnosis was 4.1% at 1 year, 11% at 5 years, and 19% at 10 years. Older age, primary MM location on the face or neck, and histologic subtype of lentigo maligna mm were significantly associated with a higher risk of SPNs. (4) Conclusions: In our population, the risk of developing SPNs was higher in patients with primary MM located on the face and neck and with the histological subtype of lentigo maligna-MM. Age also independently influences the risk. Understanding these hazard factors can aid in the development of MM guidelines with specific follow-up recommendations for individuals with the highest risk.
- Neoadjuvant intralesional methotrexate in cutaneous squamous cell carcinoma: a comparative cohort study(Wiley, 2015) Alcantara-Reifs, C. (C.); Salido-Vallejo, R. (Rafael); Moreno-Giménez, J.C. (J. C.); Corte-Sanchez, S. (S.) de la; Vélez, A. (Antonio); Cuevas-Asencio, I. (I.); González-Menchen, A. (Alberto); Garnacho-Saucedo, G.M. (Gloria Maria)Background: Intralesional methotrexate (MTX-il) has been used as neoadjuvant therapy for keratoacanthoma but has only been utilized in a few isolated cases of cutaneous squamous cell carcinoma as neoadjuvant therapy (cSCC). Objectives: The objective of this study was to evaluate the effectiveness in clinical practice of presurgical MTX-il infiltration to reduce the size of the cSCC. Safety and the impact on subsequent reconstructive surgical techniques was also assessment. Methods: Single, retrospective, observational study of two historical cohorts differentiated in time. Subjects included were diagnosed with infiltrating cSCC. Patients included in group-A received neoadjuvant MTX-il and patients included in group-B underwent scheduled surgery without prior infiltration. Univariate and multivariate analyses were performed. Results: Group-A patients (n = 43) showed an average reduction in the tumour area of 0.52 cm(2) , while in group-B (n = 43), the area increased by 0.49 cm(2) . A multivariate linear regression analysis demonstrated that MTX-il was the only independent variable that significantly reduced the tumour size [mean 42.6% (95% CI: 31.17-54.03)]. Tumours ≥2 cm in size required significantly a lower percentage of complex reconstructions (P = 0.026). Lower lip tumours showed a higher reduction in group treated with MTX-il (P = 0.045). The only complication observed was discomfort during methotrexate infiltration (60.47%). Conclusions: Neoadjuvant MTX-il reduced the presurgical size of cSCC lesions and could simplify their subsequent surgery.
- Classic Kaposi's sarcoma treated with topical 0.5% timolol gel(Wiley, 2016) García-Nieto, A. (Antonio); Alcantara-Reifs, C. (C.); Salido-Vallejo, R. (Rafael); Garnacho-Saucedo, G.M. (Gloria Maria)Kaposi’s sarcoma (KS) is an angioproliferative disorder closely associated with human herpesvirus type 8. Classic KS is found mainly in elderly males, with lesions beginning slowly and insidiously on the distal lower extremities and occasionally on the hands. Although the disease is very rarely responsible for the death of the patient, there might be complications such as ulceration, bleeding and pain in nodules on pressure areas requiring treatment (1). To date, a uniformly effective and low-risk treatment for KS has not been found, so therapeutic recommendations must be individualized.
- Frontal fibrosing alopecia: A multicenter review of 355 patients(Elsevier, 2014) Grillo, E. (Emiliano); Camacho, F.M. (Francisco M.); Rodrigues-Barata, A.R. (Ana R.); Serrano, C. (Cristina); Diaz-Ley, B. (Blanca); Aranegui, B. (Beatriz); Fernández-Crehuet, P. (Pablo); Salido-Vallejo, R. (Rafael); Serrano, S. (Salvio); Molina-Ruiz, A.M. (Ana M.); Moreno-Giménez, J.C. (J. C.); Arias-Santiago, S. (Salvador); Grimalt, R. (Ramón); Pérez-Gala, S. (Silvia); Jaén, P. (Pedro); Martorell-Calatayud, A. (Antonio); Vañó-Galván, S. (Sergio); Garnacho-Saucedo, G.M. (Gloria Maria)Background: To our knowledge, there are no large multicenter studies concerning frontal fibrosing alopecia (FFA) that could give clues about its pathogenesis and best treatment. Objective: We sought to describe the epidemiology, comorbidities, clinical presentation, diagnostic findings, and therapeutic choices in a large series of patients with FFA. Methods: This retrospective multicenter study included patients given the diagnosis of FFA. Clinical severity was classified based on the recession of the frontotemporal hairline. Results: In all, 355 patients (343 women [49 premenopausal] and 12 men) with a mean age of 61 years (range 23-86) were included. Early menopause was detected in 49 patients (14%), whereas 46 (13%) had undergone hysterectomy. Severe FFA was observed in 131 patients (37%). Independent factors associated with severe FFA after multivariate analysis were: eyelash loss, facial papules, and body hair involvement. Eyebrow loss as the initial clinical presentation was associated with mild forms. Antiandrogens such as finasteride and dutasteride were used in 111 patients (31%), with improvement in 52 (47%) and stabilization in 59 (53%). Limitations: The retrospective design is a limitation. Conclusions: Eyelash loss, facial papules, and body hair involvement were associated with severe FFA. Antiandrogens were the most useful treatment. ( J Am Acad Dermatol 2014;70:670-8.)
- Renbök phenomenon in a patient with alopecia areata universalis(American Medical Association, 2012) Ruano, J. (J.); Jimenez-Puya, R. (R.); Salido-Vallejo, R. (Rafael); Casas, E. (E.); Moreno-Giménez, J.C. (J. C.); Álvarez-López, M.A. (M. Ángeles); Vélez, A. (Antonio); Garnacho-Saucedo, G.M. (Gloria Maria)The Renbök phenomenon, or reverse Koebner phenomenon, was first reported in 1991 by Happle et al,1 who described 4 patients with extensive alopecia areata of the scalp with hair growth within plaques of psoriasis. Three additional cases have subsequently been reported,2-4 and the term was later extended to include patients with mosaic phenomena, one with alopecia areata without a nevus flammeus, and another without a congenital nevus.5,6 Whereas the Koebner phenomenon involves psoriasis of traumatic or inflammatory origin, the Renbök phenomenon occurs when some inflammatory process is inhibited by psoriasis.
- Facial Angiofibroma Severity Index (FASI): reliability assessment of a new tool developed to measure severity and responsiveness to therapy in tuberous sclerosis-associated facial angiofibroma(Oxford academic, 2014) Llorca, D. (D.); Ruano, J. (J.); Salido-Vallejo, R. (Rafael); Godoy-Gijón, E. (E.); Moreno-Giménez, J.C. (J. C.); Gomez-Fernandez, C. (Cristina); Garnacho-Saucedo, G.M. (Gloria Maria)Background. Tuberous sclerosis complex (TSC) is an autosomal dominant neurocutaneous disorder characterized by the development of multisystem hamartomatous tumours. Topical sirolimus has recently been suggested as a potential treatment for TSC-associated facial angiofibroma (FA). Aim. To validate a reproducible scale created for the assessment of clinical severity and treatment response in these patients. Methods. We developed a new tool, the Facial Angiofibroma Severity Index (FASI) to evaluate the grade of erythema and the size and extent of FAs. In total, 30 different photographs of patients with TSC were shown to 56 dermatologists at each evaluation. Three evaluations using the same photographs but in a different random order were performed 1 week apart. Test and retest reliability and interobserver reproducibility were determined. Results. There was good agreement between the investigators. Inter-rater reliability showed strong correlations (> 0.98; range 0.97–0.99) with inter-rater correlation coefficients (ICCs) for the FASI. The global estimated kappa coefficient for the degree of intra-rater agreement (test–retest) was 0.94 (range 0.91–0.97). Conclusions. The FASI is a valid and reliable tool for measuring the clinical severity of TSC-associated FAs, which can be applied in clinical practice to evaluate the response to treatment in these patients.
- Hereditary congenital hypopigmented and hyperpigmented macules (Westerhof syndrome) in two siblings(Oxford University Press, 2009) Amorrich-Campos, V. (Victoria); Salido-Vallejo, R. (Rafael); Moreno-Giménez, J.C. (J. C.); Álvarez-López, M.A. (M. Ángeles); Vélez, A. (Antonio); Garnacho-Saucedo, G.M. (Gloria Maria); Galán, M. (Manuel)S IR, In 1978 Westerhof et al. reported several members of a family with multiple hereditary congenital hypopigmented and hyperpigmented macules.1 Some affected members also showed retarded growth and mental deficiency. The authors suggested that this complex of symptoms represented a new neurocutaneous syndrome distinct from tuberous sclerosis complex (TSC). We report a 9-year-old boy who was born with multiple hypopigmented and hyperpigmented macules distributed over the trunk and extremities. The skin lesions were well defined, asymmetrical, and not confined to any dermatome (Fig. 1a). Mucous membranes were spared. Otherwise the patient was healthy. His only brother, aged 3 years, had similar congenital skin lesions (Fig. 1b). This younger child was diagnosed in utero with symmetrical retarded growth, and during his first 3 years of life has shown growth retardation at percentile < 3.
- Sustained clinical effectiveness and favorable safety profile of topical sirolimus for tuberous sclerosis – associated facial angiofibroma(Wiley, 2012) Galán-Gutierrez, M. (M.); Ruano, J. (J.); Salido-Vallejo, R. (Rafael); Moreno-Giménez, J.C. (J. C.); Vélez, A. (Antonio); Cuevas-Asencio, I. (I.); Garnacho-Saucedo, G.M. (Gloria Maria)Background Tuberous sclerosis complex (TSC) is an autosomal dominant neurocutaneous disorder characterized by the development of multisystem hamartomatous tumours. Facial angiofibroma appears in up to 80% of patients and has a considerable psychological impact. Various invasive procedures have been used, although they show limited effectiveness and potential adverse effects. Objectives To evaluate the sustained clinical benefits and safety profile of topical sirolimus applied to treat facial angiofibromas. Methods This study was a non-blinded, uncontrolled case-series comprising 10 patients with TSC-associated facial angiofibroma that was treated with 0.4% sirolimus ointment 3 times a week for 9 months. Patients were clinically evaluated at baseline and at 6, 12, 24 and 36 weeks. Plasma levels of sirolimus were determined. Results A sustained improvement was observed in erythema and in the size and extension of the lesions as early as the first weeks of treatment. Sirolimus plasma levels remained below detection limits (0.3 ng ⁄ mL) in all cases. The formula was well-tolerated with no local or systemic adverse effects. Conclusions Topical sirolimus seems to be an effective and safe medical alternative to surgery or laser-based treatments in patients with TSC-associated facial angiofibromas.