[Initial evaluation, diagnosis, staging, treatment, and follow-up of patients with primary cutaneous malignant melanoma. Consensus statement of the Network of Catalan and Balearic Melanoma Centers]

The consensus statement on the management of primary cutaneous melanoma that we present here was based on selection, discussion, review, and comparison of recent literature (including national and international guidelines). The protocols for the diagnosis, treatment, and follow-up used in the hospital centers throughout Catalonia and the Balearic Isles belonging to the Network of Catalan and Balearic Melanoma Centers were also considered. The main objective of this statement was to present the overall management of melanoma patients typically used in our region at the present time. As such, the statement was not designed to be an obligatory protocol for health professionals caring for this group of patients, and neither can it nor should it be used for this purpose. Professionals reading the statement should not therefore consider it binding on their practice, and in no case can this text be used to guarantee or seek responsibility for a given medical opinion. The group of dermatologists who have signed this statement was created 3 years ago with the aim of making our authorities aware of the importance of this complex tumor, which, in comparison with other types of cancer, we believe does not receive sufficient attention in Spain. In addition, the regular meetings of the group have produced interesting proposals for collaboration in various epidemiological, clinical, and basic applied research projects on the subject of malignant melanoma in our society.

Invisible mycosis fungoides: A diagnostic challenge

We describe a 76-year-old woman who presented persistent generalized pruritus as the only cutaneous manifestation of a cutaneous T-cell lymphoma (mycosis fungoides). No cutaneous lesions were observed throughout the patient's course. Skin biopsies obtained from normal-looking pruritic skin revealed a discrete perivascular lymphocytic infiltrate in the upper dermis and focal intraepidermal clusters of atypical lymphoid cells (Pautrier's microabscesses). PCR analysis of TCR-gamma gene disclosed a monoclonal T-cell rearrangement. Sequencing of the PCR monoclonal product identified the J(8)V(2)C(2) TCR gene rearrangement. This observation illustrates the existence of a peculiar and exceedingly rare form of mycosis fungoides characterized only by persistent pruritus unresponsive to several therapeutic approaches. The diagnostic difficulties of this rare variant are stressed.

Lipodystrophia centrifugalis abdominalis infantilis: a case report

We describe a typical case of lipodystrophia centrifugalis abdominalis infantilis. This rare disorder is almost exclusively seen in Japanese children. The patient, a 3-year-old girl of Chinese ancestry, had a depressed area of skin in the right groin which gradually spread across the abdomen. The lesion had a distinctive, slightly erythematous, raised border and regional lymphadenopathy was present.

[Stevens-Johnson syndrome after lamotrigine treatment]

We report a 18 years old female with Lennox-Gastaut syndrome under treatment with sodium valproate, carbamazepine and clonazepam. When seizures increased we stopped carbamazepine and introduced lamotrigine slowly. One month later the girl developed haemorrhagic erosions in mucoses and limbs with deterioration of her general state. Skin biopsy confirmed the diagnosis of erythema multiforme, the Stevens-Johnson's form. The immediate withdrawal of lamotrigine and treatment with antihystaminics and steroids was followed of a slowly favourable course with disappearance of symptomatology one month later. It's another case of Stevens-Johnson syndrome related to the introduction of lamotrigine in polytherapy.

Tegafur-induced acral hyperpigmentation

Four patients with colorectal cancer treated with tegafur (a fluoropyrimidine structurally similar to 5-fluorouracil) noted a macular, spotted hyperpigmentation limited to the palms, soles, nails, and glans penis. Histopathologic examination disclosed epidermal basal hyperpigmentation with a lentiginous pattern. Mucocutaneous lesions resolved spontaneously two months after treatment was discontinued. This peculiar phenomenon seems to represent a previously unreported side effect of this cytotoxic drug.

Verrucous hemangioma

Verrucous hemangioma is an infrequent variety of deep-seated capillary or cavernous hemangioma with reactive epidermal hyperplasia and a superficial component indistinguishable from those of angiokeratoma. Four cases of verrucous hemangioma are reported herein. Verrucous hemangiomas are usually congenital lesions which do not resolve spontaneously and have a tendency to recur after excision if margins are inadequate. Careful histopathologic and clinical evaluation are required for an optimal therapeutic approach.

Granulation tissue proliferation during isotretinoin treatment

Excessive, pseudotumoral granulation tissue proliferations appeared in three patients receiving isotretinoin for nodulocystic acne. A review of the literature disclosed few reports of this unusual adverse reaction. Two clinical patterns have been reported; one in a periungual location and the other occurring in the sites of acne lesions during isotretinoin therapy. Loose edematous connective tissue with small vessels and chronic inflammatory infiltrate were the histologic findings in all three cases.

Cutaneous angiomas in POEMS syndrome

POEMS syndrome is an unusual plasma cell dyscrasia with multisystemic manifestations featuring polyneuropathy, organomegaly, endocrinopathy, M protein and constant skin involvement. We have seen a 58-year-old white man presenting with generalized eruptive angiomas as a rare skin manifestation of this syndrome. We review the literature and discuss the pathogenesis of vascular proliferation in this unusual entity.