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Abril-Pérez C, Mansilla-Polo M, Escutia-Muñoz B, Sanmartín O, Garcés JR, Rodríguez-Prieto MA, Ruiz-Salas V, de Eusebio-Murillo E, Miñano-Medrano R, González-Sixto B, Artola-Igarza JL, Alfaro-Rubio A, Redondo P, Delgado-Jiménez Y, Sánchez-Schmidt JM, Allende-Markixana I, Alonso-Pacheco ML, García-Bracamonte B, de la Cueva-Dobao P, Navarro-Tejedor R, Ciudad-Blanco C, Carnero-González L, Vázquez-Veiga H, Cano-Martínez N, Serra-Guillén C, Vilarrasa E, Sánchez-Sambucety P, López-Estebaranz JL, Flórez-Menéndez Á, Martorell-Calatayud A, Gil P, Morales-Gordillo V, Toll A, Ocerin-Guerra I, Mayor-Arenal M, Suárez-Fernández R, Sainz-Gaspar L, Descalzo MA, Garcia-Doval I, Botella-Estrada R. Mohs micrographic surgery in immunosuppressed vs immunocompetent patients: Results of a prospective nationwide cohort study (REGESMOHS, Spanish registry of Mohs surgery). J Eur Acad Dermatol Venereol 2024. [PMID: 38733285 DOI: 10.1111/jdv.20103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 03/01/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND Immunosuppressed (IS) patients, particularly solid organ transplant recipients and those on immunosuppressive therapy, face a higher incidence and recurrence of nonmelanoma skin cancers (NMSC), including basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). Mohs micrographic surgery (MMS) is the preferred treatment for high-risk NMSC due to its high cure rate and margin examination capabilities. However, IS patients may experience more complications, such as surgical site infections, and a greater risk of recurrence, making their outcomes a subject of interest. OBJECTIVES This study aimed to compare IS and immunocompetent (IC) patients undergoing MMS for NMSC in terms of baseline characteristics, intra- and post-surgical complications, and postoperative recurrence rates. METHODS The study utilized data from the REGESMOHS registry, a 7-year prospective cohort study in Spain. It included 5226 patients, categorizing them into IC (5069) and IS (157) groups. IS patients included solid organ transplant recipients, those on immunosuppressive treatments, individuals with haematological tumours and HIV-positive patients. Patient data, tumour characteristics, surgical details and outcomes were collected and analysed. RESULTS IS patients demonstrated a higher proportion of SCC, multiple synchronous tumours and tumours invading deeper structures. Complex closures, unfinished MMS and more surgical sections were observed in the IS group. Although intra-operative morbidity was higher among IS patients, this difference became non-significant when adjusted for other variables such as year of surgery, antiplatelet/anticoagulant treatment or type of closure. Importantly, IS patients had a substantially higher recurrence rate (IRR 2.79) compared to IC patients. CONCLUSIONS This study suggests that IS patients may be at a higher risk of development of AE such as bleeding or tumour necrosis and are at a higher risk of tumour recurrence. Close follow-up and consideration of the specific characteristics of NMSC in IS patients are crucial. Further research with extended follow-up is needed to better understand the long-term outcomes for this patient group.
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Affiliation(s)
- Carlos Abril-Pérez
- Hospital Universitario La Fe, Valencia, Spain
- Instituto de Investigación Sanitaria La Fe (ISS La Fe), Valencia, Spain
| | - Miguel Mansilla-Polo
- Hospital Universitario La Fe, Valencia, Spain
- Instituto de Investigación Sanitaria La Fe (ISS La Fe), Valencia, Spain
| | - Begoña Escutia-Muñoz
- Hospital Universitario La Fe, Valencia, Spain
- Instituto de Investigación Sanitaria La Fe (ISS La Fe), Valencia, Spain
| | | | - Joan R Garcés
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Centro Médico Teknon, Barcelona, Spain
| | | | - Verónica Ruiz-Salas
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Centro Médico Teknon, Barcelona, Spain
| | | | | | - Beatriz González-Sixto
- Complexo Hospitalario Universitario de Pontevedra, Grupo de Investigación DIPO, IIS Galicia Sur-SERGAS-UVIGO, Pontevedra, Spain
| | | | | | | | - Yolanda Delgado-Jiménez
- Hospital Universitario Quirón Salud, Madrid, Spain
- Hospital Universitario de la Princesa, Madrid, Spain
| | | | | | | | | | | | | | - Cristina Ciudad-Blanco
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Hospital La Zarzuela, Madrid, Spain
| | | | - Hugo Vázquez-Veiga
- Complexo Hospitalario Universitario de Santiago, Santiago Compostela, Spain
| | | | | | - Eva Vilarrasa
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Centro Médico Teknon, Barcelona, Spain
| | | | | | - Ángeles Flórez-Menéndez
- Complexo Hospitalario Universitario de Pontevedra, Grupo de Investigación DIPO, IIS Galicia Sur-SERGAS-UVIGO, Pontevedra, Spain
| | | | - Pilar Gil
- Clínica Universidad de Navarra, Pamplona, Spain
| | | | | | | | | | | | - Laura Sainz-Gaspar
- Complexo Hospitalario Universitario de Santiago, Santiago Compostela, Spain
| | - Miguel A Descalzo
- Fundación Piel Sana Academia Española de Dermatología, Madrid, Spain
| | | | - Rafael Botella-Estrada
- Hospital Universitario La Fe, Valencia, Spain
- Instituto de Investigación Sanitaria La Fe (ISS La Fe), Valencia, Spain
- Universidad de Valencia, Valencia, Spain
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Escolà H, Llombart B, Escolà-Rodríguez A, Barchino-Ortiz L, Marcoval J, Alcaraz I, Beà-Ardébol S, Toll A, Miñano-Medrano R, Rodríguez-Jiménez P, López-Nuñez M, Ferrándiz-Pulido C, Jaka A, Masferrer E, Aguayo-Ortiz RS, Yébenes M, Arandes-Marcocci J, Ruiz-Salas V, Turrión-Merino L, Just M, Sánchez-Schmidt J, Leal L, Mayo-Martínez F, Haya-Martínez L, Sandoval-Clavijo A, Greta Dradi G, Delgado Y, Verdaguer-Faja J, López-Castillo D, Pujol RM, Deza G. Treatment of extramammary Paget's disease with imiquimod in a real-life setting: a multicenter retrospective analysis in Spain. Clin Exp Dermatol 2024:llae092. [PMID: 38531692 DOI: 10.1093/ced/llae092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 03/07/2024] [Accepted: 03/23/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Topical imiquimod has shown to be an effective treatment for EMPD, although available evidence supporting its use is based on case reports and small series of patients. OBJECTIVES To investigate the therapeutic outcomes and analyze potential clinico-pathological factors associated with imiquimod response in a large cohort of EMPD patients. METHODS Retrospective chart review of 125 EMPD patients treated with imiquimod at 20 Spanish tertiary-care hospitals. RESULTS During the study period, patients received 134 treatment regimens with imiquimod, with 70 (52.2%) cases achieving complete response (CR), 41 (30.6%) partial response and 23 (17.2%) no response. The cumulative CR rates at 24 and 48 weeks of treatment were 46.3% and 71.8%, respectively, without significant differences between first-time and previously treated EMPD. Larger lesions (≥6 cm; p = 0.038) and EMPD affecting >1 anatomical site (p = 0.002) were significantly associated with a worse treatment response. However, the CR rate did not differ significantly by the number of treatment applications (≤4 vs. > 4 times/week; p = 0.112). Among patients who achieved CR, 30 (42.9%) developed local recurrences during a mean follow-up period of 36 months, with an estimated 3 and 5-year recurrence free-survival of 55.7% and 36.4%, respectively. CONCLUSIONS Imiquimod appears as an effective therapeutic alternative for both first-line and previously treated EMPD lesions. However, a less favorable therapeutic response could be expected in larger lesions and those affecting >1 anatomical site. Based on our results, a 3-4 times weekly regimen of imiquimod with a treatment duration of at least 6 months could be considered an appropriate therapeutic strategy for EMPD patients.
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Affiliation(s)
- Helena Escolà
- Department of Dermatology, Hospital del Mar-Institut Mar d'Investigacions Mèdiques, Barcelona, Spain
- Department of Medicine, Universidad Autónoma de Barcelona (UAB), Barcelona, Spain
| | - Beatriz Llombart
- Department of Dermatology, Instituto Valenciano de Oncología, Valencia, Spain
| | - Alba Escolà-Rodríguez
- Pharmacy Service, Division of Medicines, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | | | - Joaquim Marcoval
- Department of Dermatology, Hospital de Bellvitge, Barcelona, Spain
| | | | | | - Agustí Toll
- Department of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | | | | | | | - Carla Ferrándiz-Pulido
- Department of Dermatology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ane Jaka
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, IGTP, Badalona, Spain
| | - Emili Masferrer
- Department of Dermatology, Hospital Universitari Mútua Terrassa, Barcelona, Spain
| | - Rafael S Aguayo-Ortiz
- Department of Dermatology, Hospital Universitari Arnau de Vilanova - Institut de Recerca Biomèdica de Lleida, Lleida, Spain
| | - Mireia Yébenes
- Department of Dermatology, Hospital Parc Taulí, Barcelona, Spain
| | | | - Verónica Ruiz-Salas
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Miquel Just
- Department of Dermatology, Hospital Joan XXIII, Tarragona, Spain
| | | | - Lorena Leal
- Department of Dermatology, Hospital del Mar-Institut Mar d'Investigacions Mèdiques, Barcelona, Spain
| | | | | | | | | | - Yolanda Delgado
- Department of Dermatology, Hospital de la Princesa, Madrid, Spain
| | - Júlia Verdaguer-Faja
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, IGTP, Badalona, Spain
| | | | - Ramon M Pujol
- Department of Dermatology, Hospital del Mar-Institut Mar d'Investigacions Mèdiques, Barcelona, Spain
- Department of Medicine, Universidad Autónoma de Barcelona (UAB), Barcelona, Spain
| | - Gustavo Deza
- Department of Dermatology, Hospital del Mar-Institut Mar d'Investigacions Mèdiques, Barcelona, Spain
- Department of Medicine, Universidad Autónoma de Barcelona (UAB), Barcelona, Spain
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3
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Escolà H, Llombart B, Escolà-Rodríguez A, Barchino-Ortiz L, Marcoval J, Alcaraz I, Beà-Ardébol S, Toll A, Miñano-Medrano R, Rodríguez-Jiménez P, López-Nuñez M, Ferrándiz-Pulido C, Jaka A, Masferrer E, Aguayo-Ortiz RS, Yébenes M, Arandes-Marcocci J, Ruiz-Salas V, Turrión-Merino L, Just M, Sánchez-Schmidt J, Leal L, Mayo-Martínez F, Haya-Martínez L, Sandoval-Clavijo A, Dradi GG, Delgado Y, Verdaguer-Faja J, López-Castillo D, Pujol RM, Deza G. Therapeutic outcomes and survival analysis of Extramammary Paget's disease: A multicentre retrospective study of 249 patients. J Am Acad Dermatol 2024; 90:66-73. [PMID: 37704106 DOI: 10.1016/j.jaad.2023.08.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/13/2023] [Accepted: 08/15/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND Evidence regarding long-term therapeutic outcomes and disease-specific survival (DSS) in Extramammary Paget's disease (EMPD) is limited. OBJECTIVES To assess the DSS and outcomes of surgical and nonsurgical therapeutic modalities in a large cohort of EMPD patients. METHODS Retrospective chart review of EMPD patients from 20 Spanish tertiary care hospitals. RESULTS Data on 249 patients with a median follow-up of 60 months were analyzed. The estimated 5-, 10-, and 15-year DSS was 95.9%, 92.9%, and 88.5%, respectively. A significantly lower DSS was observed in patients showing deep dermal invasion (≥1 mm) or metastatic disease (P < .05). A ≥50% reduction in EMPD lesion size was achieved in 100% and 75.3% of patients treated with surgery and topical therapies, respectively. Tumor-free resection margins were obtained in 42.4% of the patients after wide local excision (WLE). The 5-year recurrence-free survival after Mohs micrographic surgery (MMS), WLE with tumor-free margins, WLE with positive margins, radiotherapy, and topical treatments was 63.0%, 51.4%, 20.4%, 30.1%, and 20.8%, respectively. LIMITATIONS Retrospective design. CONCLUSIONS EMPD is usually a chronic condition with favorable prognosis. MMS represents the therapeutic alternative with the greatest efficacy for the disease. Recurrence rates in patients with positive margins after WLE are similar to the ones observed in patients treated with topical agents.
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Affiliation(s)
- Helena Escolà
- Department of Dermatology, Hospital del Mar-Institut Mar d'Investigacions Mèdiques, Barcelona, Spain; Department of Medicine, Universidad Autónoma de Barcelona (UAB), Barcelona, Spain.
| | - Beatriz Llombart
- Department of Dermatology, Instituto Valenciano de Oncología, Valencia, Spain
| | - Alba Escolà-Rodríguez
- Pharmacy Service, Division of Medicines, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | | | - Joaquim Marcoval
- Department of Dermatology, Hospital de Bellvitge, Barcelona, Spain
| | | | | | - Agustí Toll
- Department of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | | | | | | | - Carla Ferrándiz-Pulido
- Department of Dermatology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ane Jaka
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, IGTP, Badalona, Spain
| | - Emili Masferrer
- Department of Dermatology, Hospital Universitari Mútua Terrassa, Barcelona, Spain
| | - Rafael S Aguayo-Ortiz
- Department of Dermatology, Hospital Universitari Arnau de Vilanova - Institut de Recerca Biomèdica de Lleida, Lleida, Spain
| | - Mireia Yébenes
- Department of Dermatology, Hospital Parc Taulí, Barcelona, Spain
| | | | - Verónica Ruiz-Salas
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Miquel Just
- Department of Dermatology, Hospital Joan XXIII, Tarragona, Spain
| | | | - Lorena Leal
- Department of Dermatology, Hospital del Mar-Institut Mar d'Investigacions Mèdiques, Barcelona, Spain
| | | | | | | | | | - Yolanda Delgado
- Department of Dermatology, Hospital de la Princesa, Madrid, Spain
| | - Júlia Verdaguer-Faja
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, IGTP, Badalona, Spain
| | | | - Ramon M Pujol
- Department of Dermatology, Hospital del Mar-Institut Mar d'Investigacions Mèdiques, Barcelona, Spain; Department of Medicine, Universidad Autónoma de Barcelona (UAB), Barcelona, Spain
| | - Gustavo Deza
- Department of Dermatology, Hospital del Mar-Institut Mar d'Investigacions Mèdiques, Barcelona, Spain; Department of Medicine, Universidad Autónoma de Barcelona (UAB), Barcelona, Spain
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Marti-Marti I, Podlipnik S, Cañueto J, Ferrándiz-Pulido C, Deza G, Sanmartín O, Jaka A, Beà-Ardèbol S, Botella-Estrada R, Redondo P, Turrión-Merino L, Ruiz-Salas V, Masferrer E, Yébenes M, Sánchez-Schmidt JM, Gracia-Darder I, Altemir-Vidal A, Aguayo-Ortiz RS, Becerril S, Bodet-Castillo D, Leal L, Fuente MJ, Moreno-Arrones OM, Abril-Pérez C, Tomás-Velázquez A, Sandoval-Clavijo A, Toll A. Prognostic factors for satellitosis or in-transit metastasis in cutaneous squamous cell carcinoma: A multicentric cohort study. J Am Acad Dermatol 2023; 89:119-127. [PMID: 36907554 DOI: 10.1016/j.jaad.2023.02.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/06/2023] [Accepted: 02/12/2023] [Indexed: 03/12/2023]
Abstract
BACKGROUND Satellitosis or in-transit metastasis (S-ITM) has clinical outcomes comparable to node-positivity in cutaneous squamous cell carcinoma (cSCC). There is a need to stratify the risk groups. OBJECTIVE To determine which prognostic factors of S-ITM confer an increased risk of relapse and cSCC-specific-death. METHODS A retrospective, multicenter cohort study. Patients with cSCC developing S-ITM were included. Multivariate competing risk analysis evaluated which factors were associated with relapse and specific death. RESULTS Of a total of 111 patients with cSCC and S-ITM, 86 patients were included for analysis. An S-ITM size of ≥20 mm, >5 S-ITM lesions, and a primary tumor deep invasion was associated with an increased cumulative incidence of relapse (subhazard ratio [SHR]: 2.89 [95% CI, 1.44-5.83; P = .003], 2.32 [95% CI, 1.13-4.77; P = .021], and 2.863 [95% CI, 1.25-6.55; P = .013]), respectively. Several >5 S-ITM lesions were also associated with an increased probability of specific death (SHR: 3.48 [95% CI, 1.18-10.2; P = .023]). LIMITATIONS Retrospective study and heterogeneity of treatments. CONCLUSION The size and the number of S-ITM lesions confer an increased risk of relapse and the number of S-ITM an increased risk of specific-death in patients with cSCC presenting with S-ITM. These results provide new prognostic information and can be considered in the staging guidelines.
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Affiliation(s)
- Ignasi Marti-Marti
- Department of Dermatology, Hospital Clinic de Barcelona, Universitat de Barcelona, Barcelona, Spain.
| | - Sebastian Podlipnik
- Department of Dermatology, Hospital Clinic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Javier Cañueto
- Department of Dermatology, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | | | - Gustavo Deza
- Department of Dermatology, Hospital del Mar, Barcelona, Spain
| | - Onofre Sanmartín
- Department of Dermatology, Instituto Valenciano de Oncología, Valencia, Spain
| | - Ane Jaka
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Sonia Beà-Ardèbol
- Department of Dermatology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - Pedro Redondo
- Department of Dermatology, Clinica Universidad de Navarra, Pamplona/Madrid, Spain
| | - Lucía Turrión-Merino
- Department of Dermatology, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | - Verónica Ruiz-Salas
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Emili Masferrer
- Department of Dermatology, Hospital Universitari Mútua de Terrassa, Terrassa, Spain
| | - Mireia Yébenes
- Department of Dermatology, Consorci Corporació Sanitària Parc Taulí, Sabadell, Spain
| | | | - Inés Gracia-Darder
- Department of Dermatology, Hospital Universitari Son Espases, Palma, Spain
| | | | | | - Sara Becerril
- Department of Dermatology, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | | | - Lorena Leal
- Department of Dermatology, Hospital del Mar, Barcelona, Spain
| | - Maria José Fuente
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | | | - Carlos Abril-Pérez
- Department of Dermatology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | | | - Agustí Toll
- Department of Dermatology, Hospital Clinic de Barcelona, Universitat de Barcelona, Barcelona, Spain
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Ruiz-Salas V, Podlipnik S, Sandoval-Clavijo A, Sanmartin-Jiménez O, Bernia-Petit E, Bonfill-Ortí M, Bassas-Freixas P, Yebenes-Marsal M, Flórez-Menéndez Á, Solá-Ortigosa J, Just-Sarobé M, Aguayo-Ortiz R, Masferrer I Niubó E, Quintana-Codina M, Deza G, Jaka A, Fuentes MJ, Cañueto J, Toll A. Real-World Experience with Vismodegib on Advanced and Multiple BCCs: Data from the RELIVIS Study. Dermatology 2023; 239:685-693. [PMID: 37257423 DOI: 10.1159/000530813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 04/11/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Vismodegib is approved for advanced cases of basal cell carcinomas not amenable to surgery or radiotherapy. Large studies on the use of vismodegib in clinical practice are scarce. OBJECTIVES The main objective of the study was to analyse the evolution and therapeutic management of relapses and lack of response in patients who had received vismodegib for locally advanced and/or multiple basal cell carcinomas in a real-life multicentre setting. METHODS This nationwide retrospective study collected data on patients treated with vismodegib in 15 specialized centres. We included patients who first received vismodegib until intolerable toxicity, maximum response, or progressive disease. Exploratory research variables referred to patient and tumour characteristics, vismodegib effectiveness and safety, relapse rate and management, and mortality. A multivariable logistic regression model was used to identify predictors of complete clinical response. RESULTS 133 patients with advanced BCC were included in the registry. The objective response rate (ORR) was 77.5% and nearly half of the patients (45.9%) achieved complete remission. Long-term information and detailed information of subsequent treatments after a regime of vismodegib was available for 115 patients. Only 34% of the patients in this group were subsequently treated with other therapies or vismodegib rechallenge. Sixty-nine percent of the patients who had shown a complete remission with vismodegib remained free of recurrence while 30.7% relapsed. Almost half of the patients who received additional therapies after the first course of vismodegib achieved complete tumour remission. Three and 2 out of 9 patients who were rechallenged with vismodegib achieved complete and partial responses, respectively, with an ORR of 55.5%. CONCLUSION Our study confirms efficacy of vismodegib in routine clinical practice. The risk of recurrence after achieving complete response with vismodegib was lower than previous reports. Rechallenge with vismodegib is feasible and most patients responded to re-treatment.
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Affiliation(s)
- Verónica Ruiz-Salas
- Dermatology Department, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
| | - Sebastian Podlipnik
- Hospital Clinic of Barcelona, Dermatology Department, University of Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Alejandra Sandoval-Clavijo
- Hospital Clinic of Barcelona, Dermatology Department, University of Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | | | - Eduardo Bernia-Petit
- Dermatology Department, Instituto Valenciano de Oncología (IVO), Valencia, Spain
| | - Montserrat Bonfill-Ortí
- Dermatology Department, Hospital Universitari de Bellvitge, University of Barcelona, Barcelona, Spain
| | - Patricia Bassas-Freixas
- Dermatology Department, Hospital Universitari Vall d´Hebron, Autonomous University of Barcelona, Barcelona, Spain
| | - Mireia Yebenes-Marsal
- Dermatology Department, Hospital Parc Tauli, Autonomous University of Barcelona, Sabadell, Spain
| | - Ángeles Flórez-Menéndez
- Dermatology Department, Complexo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | | | - Miquel Just-Sarobé
- Dermatology Department, Hospital Universitari Joan XXIII, Tarragona, Spain
| | - Rafael Aguayo-Ortiz
- Dermatology Department, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | | | | | - Gustavo Deza
- Dermatology Department, Hospital del Mar, Barcelona, Spain
| | - Ane Jaka
- Dermatology Department, Hospital Universitari Germans Trias I Pujol, Autonomous University of Barcelona, Barcelona, Spain
| | - Maria José Fuentes
- Dermatology Department, Hospital Universitari Germans Trias I Pujol, Autonomous University of Barcelona, Barcelona, Spain
| | - Javier Cañueto
- Dermatology Department, Hospital Universitario de Salamanca, Barcelona, Spain
| | - Agustí Toll
- Hospital Clinic of Barcelona, Dermatology Department, University of Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
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Moreno-Arrones OM, Béa-Ardebol S, Mayo-Martinez F, Pérez-Pastor G, Torres-Navarro I, Bonfill-Ortí M, Deza-Vargas LG, Ruiz-Salas V, Masferrer E, Feal C, Turrión-Merino L, Toll A, Yébenes M, Galiano-Mejías S, Jaka A, Ferrandiz-Pulido C, Florez A, Hernández-Hernández N, Fernández-de-Misa R, Rios-Buceta L, Sanmartin O. Sonidegib as a locally advanced basal cell carcinoma therapy in real-life clinical setting: a national multicentre study. Actas Dermosifiliogr 2023:S0001-7310(23)00318-6. [PMID: 37088285 DOI: 10.1016/j.ad.2023.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 04/16/2023] [Accepted: 04/18/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND Basal cell carcinoma (BCC) is the most prevalent cancer. A minority of BCCs have an aggressive behaviour (laBCC) and may require hedgehog pathway inhibitors such as sonidegib as its treatment. OBJECTIVE To describe the use of sonidegib in a large number of patients and provide more data on its real-life efficacy and safety profile. METHODS We conducted a retrospective and multicentric study that included patients treated with sonidegib. Epidemiological, effectiveness and safety data were collected. RESULTS A total of 82 patients with a mean age of 73.9 years were included. Ten patients had Gorlin syndrome. Median treatment duration was 6 months. Median follow-up duration was 34.2 months. Globally, 81.7% of the patients showed clinical improvement (52.4% partial response and 29.3% complete response), 12.2% clinical stability and 6.1% disease progression. There was no statistically significant difference in clinical improvement between the 24h and 48h sonidegib posology. After 6 months of treatment, 48.8% of the patients discontinued sonidegib. Prior vismodegib treatment and recurrent primary BCC were associated with a poorer response to sonidegib. At 6 months of treatment, 68.3% of the patients experienced at least one adverse effect. CONCLUSION Sonidegib shows good effectiveness and acceptable safety profile in usual clinical practice.
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Affiliation(s)
- O M Moreno-Arrones
- Dermatology Department, Ramon y Cajal University Hospital, University of Alcala, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain.
| | - S Béa-Ardebol
- Dermatology Department, Ramon y Cajal University Hospital, University of Alcala, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - F Mayo-Martinez
- Department of Dermatology, Instituto Valenciano de Oncología, Valencia, Spain
| | - G Pérez-Pastor
- Department of Dermatology, Consorci Hospital General Universitari de Valencia, Valencia, Spain
| | - I Torres-Navarro
- Department of Dermatology; Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - M Bonfill-Ortí
- Department of Dermatology; Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - L G Deza-Vargas
- Department of Dermatology; Hospital del Mar, Barcelona, Spain
| | - V Ruiz-Salas
- Department of Dermatology Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - E Masferrer
- Dermatology Department, Hospital Universitari Mútua de Terrassa, Barcelona, Spain
| | - C Feal
- Dermatology Department, Hospital de Pontevedra, Galicia, Spain
| | - L Turrión-Merino
- Dermatology Department, Hospital Puerta de Hierro, Madrid, Spain
| | - A Toll
- Department of Dermatology, Hospital Clínic de Barcelona, University of Barcelona (UB), Barcelona, Spain
| | - M Yébenes
- Department of Dermatology, Consorci Corporació Sanitària Parc Taulí, Sabadell, Barcelona, Spain
| | - S Galiano-Mejías
- Department of Dermatology, Hospital Infanta Leonor, Madrid, España
| | - A Jaka
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - C Ferrandiz-Pulido
- Department of Dermatology, Hospital Universitari Vall d'Hebron. Facultad de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - A Florez
- Dermatology Department, Hospital de Pontevedra, Galicia, Spain
| | - N Hernández-Hernández
- Department of Dermatology. Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - R Fernández-de-Misa
- Department of Dermatology. Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - L Rios-Buceta
- Dermatology Department, Ramon y Cajal University Hospital, University of Alcala, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - O Sanmartin
- Department of Dermatology, Instituto Valenciano de Oncología, Valencia, Spain
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7
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Montero-Vilchez T, Garcés JR, Rodríguez-Prieto MA, Ruiz-Salas V, de Eusebio-Murillo E, Miñano-Medrano R, Escutia-Muñoz B, González-Sixto B, Artola-Igarza JL, Alfaro-Rubio A, Redondo P, Delgado-Jiménez Y, Sánchez-Schmidt JM, Allende-Markixana I, Alonso-Pacheco ML, García-Bracamonte B, de la Cueva-Dobao P, Navarro-Tejedor R, Ciudad-Blanco C, Carnero-González L, Vázquez-Veiga H, Cano-Martínez N, Vilarrasa E, Sánchez-Sambucety P, López-Estebaranz JL, Botella-Estrada R, Feal-Cortizas JC, Martorell-Calatayud A, Gil P, Morales-Gordillo V, Toll-Abelló A, Ocerin-Guerra I, Mayor-Arenal M, Suárez-Fernández R, Sainz-Gaspar L, Descalzo MA, Garcia-Doval I, Sanmartin-Jiménez O. Development and validation of a model to predict complex Mohs Micrographic Surgery in clinical practice: REGESMOSH scale. J Eur Acad Dermatol Venereol 2023. [PMID: 36950898 DOI: 10.1111/jdv.19056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 03/07/2023] [Indexed: 03/24/2023]
Abstract
INTRODUCTION There is still a need to develop a simple algorithm to identify patients likely to need complex Mohs Micrographic Surgery (MMS) and optimize MMS schedule. The main objectives of this study are to identify factors associated with a complex MMS and develop a predictor model of the number of stages needed in surgery and the need for a complex closure. MATERIAL AND METHODS A nationwide prospective cohort study (REGESMOHS, the Spanish Mohs surgery registry) was conducted including all patients with a histological diagnosis of basal cell carcinoma (BCC). Factors related to 3 or more stages and a complex closure (that needing a flap and/or a graft) were explored and predictive models were constructed and validated to construct the REGESMOSH scale. RESULTS 5226 patients that underwent MMS were included in the REGESMOHS registry, with 4402 (84%) having a histological diagnosis of BCC. 3689 (88.9%) surgeries only needed one or two stages and 460 (11.1%) required 3 or more stages. A model to predict the need for 3 or more stages included tumour dimension, immunosuppression, recurrence, location in risk areas, histological aggressiveness, and previous surgery. Regarding the closure type, 1616 (38.8%) surgeries were closed using a non-complex closure technique and 2552 (61.2%) needed a complex closure. A model to predict the need for a complex closure included histological aggressiveness, evolution time, patient age, maximum tumour dimension and location. CONCLUSION We present a model to predict MMS needing ≥ 3 stages and a complex closure based on epidemiological and clinical data validated in a large population (with real practice variability) including different centres that could be easily implemented in clinical practice. This model could be used to optimize surgery schedule and properly inform patients about the surgery duration.
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Affiliation(s)
| | - Joan R Garcés
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Centro Médico Teknon, Barcelona, Spain
| | | | - Verónica Ruiz-Salas
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Centro Médico Teknon, Barcelona, Spain
| | | | | | | | | | | | | | | | - Yolanda Delgado-Jiménez
- Hospital Universitario Quirón Salud, Madrid, Spain
- Hospital Universitario de la Princesa, Madrid, Spain
| | | | | | | | | | | | | | - Cristina Ciudad-Blanco
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Hospital La Zarzuela, Madrid, Spain
| | | | - Hugo Vázquez-Veiga
- Complexo Hospitalario Universitario de Santiago, Santiago Compostela, Spain
| | | | - Eva Vilarrasa
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Centro Médico Teknon, Barcelona, Spain
| | | | | | | | | | | | - Pilar Gil
- Clínica Universidad de Navarra, Pamplona, Spain
| | | | | | | | | | | | - Laura Sainz-Gaspar
- Complexo Hospitalario Universitario de Santiago, Santiago Compostela, Spain
| | - Miguel A Descalzo
- Fundación Piel Sana Academia Española de Dermatología, Madrid, Spain
| | - Ignacio Garcia-Doval
- Fundación Piel Sana Academia Española de Dermatología, Madrid, Spain
- Complexo Hospitalario Universitario de Vigo, Vigo, Spain
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8
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Miñano Medrano R, López Estebaranz J, Sanmartin-Jiménez O, Garcés J, Rodríguez-Prieto M, Vilarrasa-Rull E, de Eusebio-Murillo E, Escutia-Muñoz B, Flórez-Menéndez Á, Artola-Igarza J, Alfaro-Rubio A, Redondo P, Delgado-Jiménez Y, Sánchez-Schmidt J, Allende-Markixana I, Alonso-Pacheco M, García-Bracamonte B, de la Cueva-Dobao P, Navarro-Tejedor R, Ciudad-Blanco C, Carnero-González L, Vázquez-Veiga H, Cano-Martínez N, Ruiz-Salas V, Sánchez-Sambucety P, Botella-Estrada R, González-Sixto B, Martorell-Calatayud A, Gil P, Morales-Gordillo V, Toll-Abelló A, Ocerin-Guerra I, Mayor-Arenal M, Suárez-Fernández R, Sainz-Gaspar L, Descalzo M, García-Doval I. [Translated article] Risk of a Second Skin Cancer in a Cohort of Patients With Nonmelanoma Skin Cancer – Basal Cell Carcinoma or Squamous Cell Carcinoma – Treated With Mohs Micrographic Surgery: A National Prospective Cohort Study. Actas Dermo-Sifiliográficas 2022. [DOI: 10.1016/j.ad.2022.01.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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9
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Miñano Medrano R, López Estebaranz J, Sanmartin-Jiménez O, Garcés J, Rodríguez-Prieto M, Vilarrasa-Rull E, de Eusebio-Murillo E, Escutia-Muñoz B, Flórez-Menéndez Á, Artola-Igarza J, Alfaro-Rubio A, Redondo P, Delgado-Jiménez Y, Sánchez-Schmidt J, Allende-Markixana I, Alonso-Pacheco M, García-Bracamonte B, de la Cueva-Dobao P, Navarro-Tejedor R, Ciudad-Blanco C, Carnero-González L, Vázquez-Veiga H, Cano-Martínez N, Ruiz-Salas V, Sánchez-Sambucety P, Botella-Estrada R, González-Sixto B, Martorell-Calatayud A, Gil P, Morales-Gordillo V, Toll-Abelló A, Ocerin-Guerra I, Mayor-Arenal M, Suárez-Fernández R, Sainz-Gaspar L, Descalzo M, García-Doval I. Riesgo de aparición de segundas neoplasias cutáneas en una cohorte de pacientes diagnosticados de carcinoma queratinocítico (carcinoma basocelular y carcinoma epidermoide) tratados con cirugía de Mohs. Estudio de cohortes prospectivo nacional. Actas Dermo-Sifiliográficas 2022; 113:451-458. [DOI: 10.1016/j.ad.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 11/23/2021] [Accepted: 01/07/2022] [Indexed: 11/29/2022] Open
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10
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Tomás-Velázquez A, Sanmartin-Jiménez O, Garcés JR, Rodríguez-Prieto MA, Ruiz-Salas V, De Eusebio-Murillo E, Miñano-Medrano R, Escutia-Muñoz B, Flórez-Menéndez Á, Artola-Igarza JL, Alfaro-Rubio A, Gil P, Delgado-Jiménez Y, Sanchez-Schmidt JM, Allende-Markixana I, Alonso-Pacheco ML, García-Bracamonte B, De la Cueva-Dobao P, Navarro-Tejedor R, Ciudad-Blanco C, Carnero-González L, Vázquez-Veiga H, Cano-Martínez N, Vilarrasa-Rull E, Sanchez-Sambucety P, López-Estebaranz JL, Botella-Estrada R, Gonzalez-Sixto B, Martorell-Calatayud A, Morales-Gordillo V, Toll-Abelló A, Ocerin-Guerra I, Mayor-Arenal M, Suárez-Fernández R, Sainz-Gaspar L, Descalzo MA, García-Doval I, Redondo P. Risk Factors and Rate of Recurrence after Mohs Surgery in Basal Cell and Squamous Cell Carcinomas: A Nationwide Prospective Cohort (REGESMOHS, Spanish Registry of Mohs Surgery). Acta Derm Venereol 2021; 101:adv00602. [PMID: 34694418 PMCID: PMC9455311 DOI: 10.2340/actadv.v101.544] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Randomized studies to assess the efficacy of Mohs micrographic surgery in basal cell and squamous cell carcinomas are limited by methodological and ethical issues and a lack of long follow-up periods. This study presents the “real-life” results of a nationwide 7-years cohort on basal cell carcinoma and squamous cell carcinoma treated with Mohs micrographic surgery. A prospective cohort was conducted in 22 Spanish centres (from July 2013 to February 2020) and a multivariate analysis, including characteristics of patients, tumours, surgeries and follow-up, was performed. A total of 4,402 patients followed up for 12,111 patientyears for basal cell carcinoma, and 371 patients with 915 patient-years of follow-up for squamous cell carcinoma were recruited. Risk factors for recurrence included age, non-primary tumours and more stages or unfinished surgeries for both tumours, and immunosuppression for squamous cell carcinoma. Incidence rates of recurrence were 1.3 per 100 person-years for basal cell carcinoma (95% confidence interval 1.1– 1.5) and 4.5 for squamous cell carcinoma (95% confidence interval 3.3–6.1), being constant over time (0–5 years). In conclusion, follow-up strategies should be equally intense for at least the first 5 years, with special attention paid to squamous cell carcinoma (especially in immunosuppressed patients), elderly patients, non-primary tumours, and those procedures requiring more stages, or unfinished surgeries.
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Affiliation(s)
- Alejandra Tomás-Velázquez
- Department of Dermatology, University Clinic of Navarra / Fundación Piel Sana, ES-28008 Madrid, Spain.
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11
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Ruiz-Salas V, Sanmartin-Jiménez O, Garcés JR, Vilarrasa E, Miñano-Medrano R, Escutia-Muñoz B, Flórez-Menéndez Á, Artola-Igarza JL, Alfaro-Rubio A, Redondo P, Delgado-Jiménez Y, Sánchez-Schmidt J, Allende-Markixana I, García Bracamonte B, de la Cueva-Dobao P, Ciudad C, Carnero-González L, Vázquez-Veiga H, Sánchez-Sambucety P, Estebaranz JL, Botella-Estrada R, González-Sixto B, Martorell A, Morales-Gordillo V, Toll-Abelló A, Mayor-Arenal M, Suárez-Fernández R, Sainz-Gaspar L, Descalzo MA, Garcia-Doval I. Complications Associated with Mohs Micrographic Surgery: Data from the Nationwide Prospective Cohort REGESMOHS. Dermatology 2021; 238:320-328. [PMID: 34380138 DOI: 10.1159/000517010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 04/27/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Large prospective studies on the safety of Mohs micrographic (MMS) surgery are scarce, and most focus on a single type of surgical adverse event. Mid-term scar alterations and functional loss have not been described. OBJECTIVES To describe the risk of MMS complications and the risk factors for them. METHODS A nationwide prospective cohort collected all adverse events on consecutive patients in 22 specialised centres. We used multilevel mixed-effects logistic regression to find out factors associated with adverse events. RESULTS 5,017 patients were included, with 14,421 patient-years of follow-up. 7.0% had some perioperative morbidity and 6.5% had mid-term and scar-related complications. The overall risk of complications was mainly associated with use of antiaggregant/anticoagulant and larger tumours, affecting deeper structures, not reaching a tumour-free border, and requiring complex repair. Age and outpatient setting were not linked to the incidence of adverse events. Risk factors for haemorrhage (0.9%) were therapy with antiaggregant/anticoagulants, tumour size, duration of surgery, and unfinished surgery. Wound necrosis (1.9%) and dehiscence (1.0%) were associated with larger defects and complex closures. Immunosuppression was only associated with an increased risk of necrosis. Surgeries reaching deeper structures, larger tumours and previous surgical treatments were associated with wound infection (0.9%). Aesthetic scar alterations (5.4%) were more common in younger patients, with larger tumours, in H-area, and in flap and complex closures. Risk factors for functional scar alterations (1.7%) were the need for general anaesthesia, larger tumours that had received previous surgery, and flaps or complex closures. CONCLUSIONS MMS shows a low risk of complications. Most of the risk factors for complications were related to tumour size and depth, and the resulting need for complex surgery. Antiaggregant/anticoagulant intake was associated with a small increase in the risk of haemorrhage, that probably does not justify withdrawal. Age and outpatient setting were not linked to the risk of adverse events.
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Affiliation(s)
- Verónica Ruiz-Salas
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Centro Médico Teknon, Barcelona, Spain
| | | | - Joan R Garcés
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Centro Médico Teknon, Barcelona, Spain
| | - Eva Vilarrasa
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Centro Médico Teknon, Barcelona, Spain
| | | | | | | | | | | | | | - Yolanda Delgado-Jiménez
- Hospital Universitario Quirón Salud, Madrid, Spain.,Hospital Universitario de la Princesa, Madrid, Spain
| | | | | | | | | | - Cristina Ciudad
- Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Hospital La Zarzuela, Madrid, Spain
| | | | - Hugo Vázquez-Veiga
- Complexo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | | | | | | | | | | | | | | | | | | | - Laura Sainz-Gaspar
- Complexo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | | | - Ignacio Garcia-Doval
- Fundación Piel Sana Academia Española de Dermatología, Madrid, Spain.,Complexo Hospitalario Universitario de Vigo, Vigo, Spain
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12
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Oro-Ayude M, González-Sixto B, Sanmartin-Jiménez O, Garcés JR, Rodríguez-Prieto MA, Ruiz-Salas V, de Eusebio-Murillo E, Miñano-Medrano R, Escutia-Muñoz B, Feal Cortizas C, Artola-Igarza JL, Alfaro-Rubio A, Redondo P, Delgado-Jiménez Y, Sánchez-Schmidt JM, Allende-Markixana I, Alonso-Pacheco ML, García-Bracamonte B, de la Cueva-Dobao P, Navarro-Tejedor R, Ciudad-Blanco C, Carnero-González L, Vázquez-Veiga H, Cano-Martínez N, Vilarrasa-Rull E, Sánchez-Sambucety P, López-Estebaranz JL, Botella-Estrada R, Martorell-Calatayud A, Gil P, Morales-Gordillo V, Toll-Abelló A, Ocerin-Guerra I, Mayor-Arenal M, Suárez-Fernández R, Sainz-Gaspar L, Descalzo MA, Garcia-Doval I, Flórez Á. Mohs surgery: a long-term, nationwide prospective cohort to describe recurrence rate and risk factors (REGESMOHS, Spanish Registry of Mohs Surgery). J Eur Acad Dermatol Venereol 2021; 36:e35-e37. [PMID: 34374137 DOI: 10.1111/jdv.17597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 07/21/2021] [Accepted: 07/29/2021] [Indexed: 11/29/2022]
Affiliation(s)
- M Oro-Ayude
- Complexo Universitario Hospitalario Pontevedra, Pontevedra, Spain
| | - B González-Sixto
- Complexo Universitario Hospitalario Pontevedra, Pontevedra, Spain
| | | | - J R Garcés
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Centro Médico Teknon, Barcelona, Spain
| | | | - V Ruiz-Salas
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Centro Médico Teknon, Barcelona, Spain
| | | | | | | | - C Feal Cortizas
- Complexo Universitario Hospitalario Pontevedra, Pontevedra, Spain
| | | | | | - P Redondo
- Clínica Universidad de Navarra, Pamplona, Spain
| | - Y Delgado-Jiménez
- Hospital Universitario Quirón Salud, Madrid, Spain.,Hospital Universitario de la Princesa, Madrid, Spain
| | | | | | | | | | | | | | - C Ciudad-Blanco
- Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Hospital La Zarzuela, Madrid, Spain
| | | | - H Vázquez-Veiga
- Complexo Hospitalario Universitario de Santiago, Santiago Compostela, Spain
| | - N Cano-Martínez
- Hospital Infanta Leonor, Madrid, Spain.,Hospital La Zarzuela, Madrid, Spain
| | - E Vilarrasa-Rull
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Centro Médico Teknon, Barcelona, Spain
| | | | | | | | | | - P Gil
- Clínica Universidad de Navarra, Pamplona, Spain
| | | | | | | | | | | | - L Sainz-Gaspar
- Complexo Hospitalario Universitario de Santiago, Santiago Compostela, Spain
| | - M A Descalzo
- Fundación Piel Sana Academia Española de Dermatología, Madrid, Spain
| | - I Garcia-Doval
- Fundación Piel Sana Academia Española de Dermatología, Madrid, Spain
| | - Á Flórez
- Complexo Universitario Hospitalario Pontevedra, Pontevedra, Spain
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13
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Nieto-Benito LM, Ciudad-Blanco C, Sanmartin-Jimenez O, Garces JR, Rodríguez-Prieto MA, Vilarrasa E, de Eusebio-Murillo E, Miñano-Medrano R, Escutia-Muñoz B, Gonzalez-Sixto B, Artola-Igarza JL, Alfaro Rubio A, Redondo P, Delgado-Jiménez Y, Sánchez-Schmidt JM, Allende-Markixana I, Alonso-Pacheco ML, García-Bracamonte B, de la Cueva Dobao P, Navarro-Tejedor R, Suarez-Fernández R, Carnero-González L, Vázquez-Veiga H, Barchino-Ortiz L, Ruiz-Salas V, Sánchez-Sambucety P, López-Estebaranz JL, Botella-Estrada R, Feal-Cortizas C, Martorell Calatayud A, Gil P, Morales-Gordillo V, Toll-Abelló A, Ocerin-Guerra I, Mayor-Arenal M, Garcia-Donoso C, Cano-Martinez N, Sainz-Gaspar L, Descalzo MA, Garcia-Doval I. Mohs micrographic surgery in dermatofibrosarcoma protuberans: Rate and risk factors for recurrence in a prospective cohort study from the Spanish Registry of Mohs Surgery (REGESMOHS) and review of the literature. Exp Dermatol 2021; 30:717-722. [PMID: 33523531 DOI: 10.1111/exd.14291] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 01/07/2021] [Accepted: 01/17/2021] [Indexed: 12/14/2022]
Abstract
Characterization of patients, surgery procedures and the risk factors for dermatofibrosarcoma protuberans (DFSP) recurrences is poorly defined. In this study, we aimed to describe the demographics, tumor characteristics and interventions of DFSP treated with Mohs micrographic surgery (MSS) to determine the rate and risk factors for recurrence. Data were collected from REGESMOHS, a nationwide prospective cohort study of patients treated with MMS in Spain. From July 2013 to February 2020, 163 patients with DFSP who underwent MMS were included. DFSP was mostly located on trunk and extremities. Recurrent tumors had deeper tumor invasion and required higher number of MMS stages. Paraffin MMS was the most frequently used technique. Overall recurrence rate was 0.97 cases/100 person-years (95% IC = 0.36-2.57). No differences were found in epidemiological, tumor, surgery characteristics or surgical technique (frozen or paraffin MMS [p = 0.6641]) in terms of recurrence. Median follow-up time was 28.6 months with 414 patient-years of follow-up. In conclusion, we found an overall low recurrence rate of DFSP treated with MMS. None of the studied risk factors, including MMS techniques, was associated with higher risk for recurrence.
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Affiliation(s)
| | - Cristina Ciudad-Blanco
- Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Hospital La Zarzuela, Madrid, Spain
| | | | - Joan R Garces
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Centro Médico Teknon, Barcelona, Spain
| | | | - Eva Vilarrasa
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Centro Médico Teknon, Barcelona, Spain
| | | | | | | | | | | | | | | | - Yolanda Delgado-Jiménez
- Hospital Universitario Quirón Salud, Madrid, Spain.,Hospital Universitario de la Princesa, Madrid, Spain
| | | | | | | | | | | | | | | | | | - Hugo Vázquez-Veiga
- Complexo Hospitalario Universitario de Santiago, Santiago Compostela, Spain
| | | | | | | | | | | | | | | | - Pilar Gil
- Clínica Universidad de Navarra, Pamplona, Spain
| | | | | | | | | | | | | | - Laura Sainz-Gaspar
- Complexo Hospitalario Universitario de Santiago, Santiago Compostela, Spain
| | - Miguel A Descalzo
- Fundación Piel Sana Academia Española de Dermatología, Madrid, Spain
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14
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Delgado Jiménez Y, Camarero-Mulas C, Sanmartín-Jiménez O, Garcés JR, Rodríguez-Prieto MÃ, Alonso-Alonso T, Miñano Medrano R, López-Estebaranz JL, de Eusebio Murillo E, Redondo P, Ciudad-Blanco C, Toll A, Artola Igarza JL, Allende Markixana I, Suarez Fernández R, Alfaro Rubio A, Alonso Pacheco ML, Vázquez-Veiga H, de la Cueva Dobao P, Ruiz-Salas V, Vilarrasa E, Barchino L, Morales-Gordillo V, Ocerin-Guerra I, Navarro Tejedor R, Hueso L, Mayor Arenal M, Seoane-Pose MJ, Cano-Martinez N, Garcia-Doval I, Descalzo MA. Differences of Mohs micrographic surgery in basal cell carcinoma versus squamous cell carcinoma. Int J Dermatol 2018; 57:1375-1381. [DOI: 10.1111/ijd.14223] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 07/13/2018] [Accepted: 08/21/2018] [Indexed: 12/17/2022]
Affiliation(s)
| | | | | | - Joan R. Garcés
- Hospital de la Santa Creu i Sant Pau Universitat Autònoma de Barcelona; Barcelona Spain
- Centro Médico Teknon Barcelona; Barcelona Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Verónica Ruiz-Salas
- Hospital de la Santa Creu i Sant Pau Universitat Autònoma de Barcelona; Barcelona Spain
| | - Eva Vilarrasa
- Hospital de la Santa Creu i Sant Pau Universitat Autònoma de Barcelona; Barcelona Spain
- Centro Médico Teknon Barcelona; Barcelona Spain
| | | | | | | | | | | | | | | | | | - Ignacio Garcia-Doval
- Unidad de investigación; Fundación Piel Sana Academia Española de Dermatología; Madrid Spain
| | - Miguel A. Descalzo
- Unidad de investigación; Fundación Piel Sana Academia Española de Dermatología; Madrid Spain
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Aluma-Tenorio MS, Ávila-Álvarez A, Jaimes N, Caballero-Uribe N, González A, Terzian LR, Ocampo-Candiani J, Zuluaga MA, Garza-Rodríguez V, Tamayo-Betancur MC, Cuesta-Castro DP, Garcés JR, Ruiz-Salas V, Goldberg L, Kimyai-Asadi A. Basal cell carcinoma treated with Mohs micrographic surgery in young Ibero-American patients. Int J Dermatol 2018; 57:1447-1453. [PMID: 30168850 DOI: 10.1111/ijd.14195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 07/15/2018] [Accepted: 08/01/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND The incidence of basal cell carcinoma (BCC) in younger individuals has increased in recent decades. However, the characteristics of BCCs in this population, especially in Ibero-Latin American countries, have not been completely defined. OBJECTIVE To describe the demographic, clinical, and histopathological characteristics of BCCs in patients younger than 40 treated with Mohs Micrographic Surgery (MMS). MATERIALS AND METHODS A multicenter, retrospective study conducted between January 2009 and December 2014, in five Ibero-American countries, included biopsy-proven BCCs in patients younger than 40 that were treated with MMS. Demographic, clinical, histopathological, and surgical characteristics were described. RESULTS The study included 301 tumors in 241 patients, of whom 61% were female. The most common Fitzpatrick phototype was III. The most common histological subtypes were nodular (37.5%) and infiltrative (18.9%). Perineural invasion was encountered in 1.7%, and tumor clearance was achieved in 87.4% within two stages of MMS. CONCLUSIONS This is the first Ibero-Latin American transnational study describing the characteristics of BCCs in young patients treated with MMS. Despite darker skin phototypes in this population, BCCs can occur in early ages and may present with aggressive features. Therefore, MMS may be considered an appropriate first-line treatment option in this population.
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Affiliation(s)
| | | | - Natalia Jaimes
- Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Natalia Caballero-Uribe
- Aurora, Centro Especializado en Cáncer de Piel, Medellín, Colombia.,Universidade do federal do ABC, Santo André, SP, Brazil
| | - Abel González
- Instituto Médico Especializado Alexander Fleming, Buenos Aires, Argentina.,Instituto de Oncologia, Ángel H. Roffo, Universidad de Buenos Aires, Buenos Aires, Argentina
| | | | - Jorge Ocampo-Candiani
- Facultad de Medicina. Servicio de Dermatología, Universidad Autónoma de Nuevo León. Hospital Universitario, Monterrey, México
| | - María Alejandra Zuluaga
- Facultad de Medicina. Servicio de Dermatología, Universidad Autónoma de Nuevo León. Hospital Universitario, Monterrey, México
| | - Verónica Garza-Rodríguez
- Facultad de Medicina. Servicio de Dermatología, Universidad Autónoma de Nuevo León. Hospital Universitario, Monterrey, México
| | | | | | - Joan Ramón Garcés
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Centro Médico Teknon, Barcelona, Catalunya, Spain
| | - Verónica Ruiz-Salas
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Centro Médico Teknon, Barcelona, Catalunya, Spain
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16
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Camarero-Mulas C, Delgado Jiménez Y, Sanmartín-Jiménez O, Garcés J, Rodríguez-Prieto M, Alonso-Alonso T, Miñano Medrano R, López-Estebaranz J, de Eusebio Murillo E, Redondo P, Ciudad-Blanco C, Toll-Abelló A, Artola Igarza J, Allende Markixana I, Suarez Fernández R, Alfaro Rubio A, Alonso Pacheco M, Vázquez-Veiga H, de la Cueva Dobao P, Ruiz-Salas V, Vilarrasa Rull E, Barchino L, Morales-Gordillo V, Ocerin-Guerra I, Navarro Tejedor R, Hueso L, Mayor Arenal M, Seoane-Pose M, Cano-Martinez N, Garcia-Doval I, Descalzo M. Mohs micrographic surgery in the elderly: comparison of tumours, surgery and first-year follow-up in patients younger and older than 80 years old in REGESMOHS. J Eur Acad Dermatol Venereol 2017; 32:108-112. [DOI: 10.1111/jdv.14586] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 09/05/2017] [Indexed: 11/26/2022]
Affiliation(s)
| | - Y. Delgado Jiménez
- Hospital de la Princesa; Madrid Spain
- Hospital Universitario Quirón Salud Madrid; Madrid Spain
| | | | - J.R. Garcés
- Hospital de la Santa Creu i Sant Pau; Barcelona Spain
- Centro Médico Teknon; Barcelona Spain
| | | | | | | | | | | | - P. Redondo
- Clínica Universidad de Navarra; Pamplona Spain
| | - C. Ciudad-Blanco
- Hospital La Zarzuela; Madrid Spain
- Hospital Gregorio Marañón; Madrid Spain
| | | | | | | | | | | | | | | | | | - V. Ruiz-Salas
- Hospital de la Santa Creu i Sant Pau; Barcelona Spain
| | - E. Vilarrasa Rull
- Hospital de la Santa Creu i Sant Pau; Barcelona Spain
- Centro Médico Teknon; Barcelona Spain
| | | | | | | | | | - L. Hueso
- Hospital Manises; Valencia Spain
| | | | | | - N. Cano-Martinez
- Hospital La Zarzuela; Madrid Spain
- Hospital Infanta Leonor; Madrid Spain
| | - I. Garcia-Doval
- Unidad de investigación; Fundación Piel Sana Academia Española de Dermatología; Madrid Spain
| | - M.A. Descalzo
- Unidad de investigación; Fundación Piel Sana Academia Española de Dermatología; Madrid Spain
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17
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Ruiz-Salas V, Garcés JR, Miñano Medrano R, Alonso-Alonso T, Rodríguez-Prieto MÁ, López-Estebaranz JL, Sanmartín-Jiménez O, Guillén Barona C, Delgado Jiménez Y, Toll-Abelló A, Vargas Diez E, Ciudad Blanco C, Alfaro Rubio A, Allende Markixana I, de Eusebio Murillo E, Manubens-Mercadé E, Vázquez-Veiga H, Barchino Ortiz L, García-Doval I, Redondo Bellón P. Description of Patients Undergoing Mohs Surgery in Spain: Initial Report on Data From the Spanish Registry of Mohs Surgery (REGESMOHS). Actas Dermosifiliogr 2015; 106:562-8. [PMID: 26028578 DOI: 10.1016/j.ad.2015.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 04/02/2015] [Accepted: 04/07/2015] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION The Spanish registry of Mohs micrographic surgery started collecting data in July 2013. The aim of the registry is to report on the use of this technique in Spain and the outcomes achieved. In the present article, we describe the characteristics of patients and the tumors treated. MATERIAL AND METHODS This is a prospective cohort study of patients treated with Mohs micrographic surgery. The participating centers are hospitals where at least one intervention of this type is performed each week. All patients considered for Mohs micrographic surgery in participating centers are included in the registry except those who have been declared legally incompetent. RESULTS Between July 2013 and October 2014, data from 655 patients were included in the registry. The most common tumor involved was basal cell carcinoma, and the most common histological subtype was infiltrative basal cell carcinoma. Most of the tumors treated were located on the face or scalp, and the most common site was the nose. Almost 40% of the tumors treated were recurrent or persistent, and preoperative tumor size was similar to that reported in other European studies and in Australia. In total, 45.5% of patients had received previous surgical treatment. CONCLUSION The findings are similar to those reported in other studies, and the data collected are useful for assessing whether the results of studies carried out elsewhere are applicable in Spain.
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Affiliation(s)
- V Ruiz-Salas
- Hospital de la Santa Creu i Sant Pau, Barcelona, España.
| | - J R Garcés
- Hospital de la Santa Creu i Sant Pau, Barcelona, España; Hospital Quirón Teknon, Barcelona, España
| | - R Miñano Medrano
- Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | | | | | | | | | | | - Y Delgado Jiménez
- Clínica Quirón, Madrid, España; Hospital de La Princesa, Madrid, España
| | | | | | - C Ciudad Blanco
- Hospital La Zarzuela, Madrid, España; Hospital Gregorio Marañón, Madrid, España
| | | | | | | | | | - H Vázquez-Veiga
- Complexo Hospitalario Universitario de Santiago, Santiago de Compostela, A Coruña, España
| | - L Barchino Ortiz
- Hospital La Zarzuela, Madrid, España; Hospital Gregorio Marañón, Madrid, España
| | - I García-Doval
- Unidad de Investigación, Fundación Academia Española de Dermatología, Madrid, España
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18
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Ruiz-Salas V, Alegre M, López-Ferrer A, Garcés J. Vismodegib: A Review. Actas Dermo-Sifiliográficas (English Edition) 2014. [DOI: 10.1016/j.adengl.2013.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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19
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Ruiz-Salas V, Alegre M, López-Ferrer A, Garcés JR. Vismodegib: a review. Actas Dermosifiliogr 2013; 105:744-51. [PMID: 24359667 DOI: 10.1016/j.ad.2013.09.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2013] [Revised: 09/19/2013] [Accepted: 09/28/2013] [Indexed: 12/31/2022] Open
Abstract
In January 2012, vismodegib (Erivedge, manufactured by Genentech) became the first selective inhibitor of the Hedgehog signaling pathway to be approved by the US Food and Drug Administration for the treatment of locally advanced and metastatic basal cell carcinoma. The drug selectively binds to Smoothened, a 7-helix transmembrane receptor, thereby inhibiting activation of transcription factors of the glioma-associated oncogene family and suppressing tumor proliferation and growth. Studies published to date have assessed the efficacy of vismodegib according to clinical and radiologic outcomes but little information is available on the molecular mechanisms underpinning the proven clinical efficacy of the drug. This review will cover recent data on the Hedgehog signaling pathway and data from clinical trials with vismodegib in the treatment of basal cell carcinoma, and will consider its use in other types of tumor.
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Affiliation(s)
- V Ruiz-Salas
- Servicio de Dermatología, Hospital de la Santa Creu i Sant Pau, Barcelona, España.
| | - M Alegre
- Servicio de Dermatología, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - A López-Ferrer
- Servicio de Dermatología, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - J R Garcés
- Servicio de Dermatología, Hospital de la Santa Creu i Sant Pau, Barcelona, España
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