BACKGROUNDThe prognostic value of sentinel lymph node (SLN) biopsy findings and mitotic activity in melanoma has been confirmed in the literature, but the relation between them has not been well ...established.OBJECTIVESThe main objective was to describe and analyze the correlation between SLN biopsy results and the mitotic rate in patients treated for melanoma in our hospital.METHODSA total of 139 consecutive patients who underwent SLN biopsy between May 2001 and May 2009 were included. The relation between the mitotic rate and SLN status was analyzed with the χ(2) test and the Fischer exact test.RESULTSThe correlation between the 2 variables was nonsignificant (P =.071) in the patient series overall, but a significant association was found in the subgroup of patients with tumors of Breslow thickness between 1 and 4mm (P =.034). The likelihood (odds ratio) of SLN positivity with a mitotic rate of less than 1 mitosis/mm2 in this subgroup was 0.838 (95% CI, 0.758-0.926).CONCLUSIONSOur findings support use of the mitotic rate to predict SLN status in melanoma tumors of intermediate thickness. Our study also shows the need for further investigation of the relation between these 2 variables in thin and thick tumors.
Abstract Background The prognostic value of sentinel lymph node (SLN) biopsy findings and mitotic activity in melanoma has been confirmed in the literature, but the relation between them has not been ...well established. Objectives The main objective was to describe and analyze the correlation between SLN biopsy results and the mitotic rate in patients treated for melanoma in our hospital. Methods A total of 139 consecutive patients who underwent SLN biopsy between May 2001 and May 2009 were included. The relation between the mitotic rate and SLN status was analyzed with the χ2 test and the Fisher exact test. Results The correlation between the 2 variables was nonsignificant ( P =.071) in the patient series overall, but a significant association was found in the subgroup of patients with tumors of Breslow thickness between 1 and 4 mm ( P =.034). The likelihood (odds ratio) of SLN positivity with a mitotic rate of less than 1 mitosis/mm2 in this subgroup was 0.838 (95% CI, 0.758-0.926). Conclusions Our findings support use of the mitotic rate to predict SLN status in melanoma tumors of intermediate thickness. Our study also shows the need for further investigation of the relation between these 2 variables in thin and thick tumors.
Abstract Introduction Psoriasis is a chronic inflammatory disease associated with an increased risk of ischemic coronary artery disease (CAD) in some populations. We aimed to determine the ...association between these 2 diseases in our geographic area. Material and method We performed a cross-sectional study of patient records between 2005 and 2012 in the database (Abucacis, Datamart) that contains all medical case histories in the province of Castellón, Spain. Patients diagnosed with psoriasis were compared with a control group of patients diagnosed with melanocytic nevus. The prevalence of CAD and the presence or absence of the main cardiovascular risk factors were analyzed in each group. Results A total of 9181 patients with psoriasis and 21925 with melanocytic nevus were studied. Univariate logistic regression analysis showed that CAD was significantly associated with psoriasis, age (in years), sex, hypertension, diabetes mellitus, dyslipidemia, and obesity ( P < .05). On adjustment for age, sex, and the other cardiovascular risk factors, multivariate regression analysis established that psoriasis was independently associated with CAD ( P < .029). Conclusion Our findings in a large sample of patients in a Mediterranean area support the hypothesis that patients in this population have an increased risk of ischemic CAD.
: Phacomatosis pigmentokeratotica is a rare syndrome defined by the association of an organoid nevus occasionally with sebaceous differentiation, a speckled lentiginous nevus, and other ...extracutaneous anomalies. The disorder is a consequence of the so‐called twin spot genetic mechanism. We describe the first occurrence involving malignant degeneration of both nevus components, giving rise to three basal cell carcinomas over the sebaceous nevus and a malignant melanoma of the superficial spreading type over the speckled lentiginous nevus. This observation, in concert with the other instances reported in the literature, points to the need for adequate patient follow‐up to ensure early detection and treatment of any possible associated malignant degeneration.
: Lymphangioma circumscriptum is an uncommon hamartomatous malformation that is not only localized to an area of skin, but also spreads to subcutaneous tissue and muscle (Whimster's hypothesis). We ...describe a 7‐year‐old boy with a bluish plaque on the left side of the back and abdomen with clusters of translucent vesicles (frog spawn). Magnetic resonance imaging showed the lymphangioma had spread to muscles and even fat adjacent to the left kidney. We decided against radical surgery as it would have been too aggressive, and limited excision can produce new surface lymphangiomas.
Conventional systemic treatments for patients with psoriasis are associated with multiple adverse effects that require continuous monitoring. The introduction of new biological agents such as ...etanercept, a fully human fusion protein, has permitted individualisation of patients' treatment according to disease stage. The drug is a competitive inhibitor of tumour necrosis factor-alpha (TNFalpha) that prevents interaction between this cytokine and its cell surface receptors. Etanercept also modulates the activity of other inflammatory cytokines and does not induce complement-mediated cell lysis in vitro. The main source of information regarding etanercept safety comes from studies in patients with rheumatoid arthritis. The most common adverse effect during drug administration is mild injection site reactions. There is no increase in the overall incidence of infections compared with placebo, although there have been several reports of infections caused by intracellular organisms (Mycobacterium tuberculosis, Listeria monocytogenes, and Mycobacterium avium intracellulare). Therefore, combination of this drug with corticosteroids must be carefully monitored and should be avoided in patients with established sepsis. There are no data showing that treatment with etanercept results in an increase in the occurrence of malignant neoplasms. However, caution is recommended in use of etanercept in patients with a current or past history of demyelinating disease. Etanercept must be used with extreme caution in patients with heart failure because of several reports indicating a worsening or de novo occurrence of congestive heart failure while receiving the drug. Monitoring of autoantibodies is not currently considered necessary as they do not predict response, toxicity or autoimmune events. The presence of non-neutralising antibodies to the TNF receptor fragment or other protein components of etanercept has not been related to a decrease in drug response or adverse reactions. Etanercept does not generally modify the course of inflammatory bowel disease. When combined with other systemic therapies for psoriasis, current data do not show an increase in adverse events. In patients with hepatitis C viral infection, etanercept does not increase transaminase levels or viral load and in some instances has allowed the concomitant use of interferon which had previously been discontinued because of a worsening of psoriasis. Etanercept is rated as a US FDA category B drug in pregnancy. However, its use is not recommended in pregnant women unless the benefit-risk ratio greatly favours its use. Etanercept is not recommended for use in lactating women. Etanercept represents a relevant treatment for psoriasis, efficacious over many weeks and safe but special care should be taken to avoid the potential risks.
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