[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.

[Cerebrotendinous xanthomatosis: report of 4 patients]

Cerebrotendinous xanthomatosis (CTX) is an uncommon autosomal recessive disease caused by mutation of the CYP27A1 gene. It is characterized by the presence of xanthomas in different tissues, principally brain and tendon, due to the accumulation of beta-cholestanol. Diagnosis is confirmed by measurement of serum beta-cholestanol and urinary bile alcohol levels. Therapy with chenodeoxycholic acid has been shown to be the most effective treatment and can halt progression of the disease. We present 4 patients with a history of neurological disorders since childhood and who were diagnosed with CTX after developing tendon xanthomas. Although diagnostic suspicion depends to a large extent on recognition of tendon xanthomas, these are not an early sign of the disease, which can present with neurological disorders, cataracts, and chronic diarrhea. Early diagnosis of CTX therefore rests on measurement of serum beta-cholestanol levels, even in absence of tendon xanthomas.

[Anticoagulation and antiplatelet therapy in dermatology]

An increasing number of patients who are receiving anticoagulation or antiplatelet therapy require cutaneous surgery. Such pharmacotherapies are usually suspended based on experience in gynecologic, thoracic, and abdominal surgery. However, this practice may increase the risk of suffering a thromboembolic event. We review perioperative management of anticoagulant and antiplatelet therapy, complications associated with suspending therapy, and side effects.

Cervico-thoracic lipoma associated with occult syringohydromyelia

Cutaneous lesions in the midline may be hallmarks of an occult spinal dysraphism. They rarely may occur in the cervical and thoracic regions. We report a 9-year-old girl with a cervico-thoracic lipoma associated with an underlying syringohydromyelia. Early detection of potentially complicated conditions can prevent the occurrence of irreversible neurologic damage.

Clinical patterns of cutaneous nontuberculous mycobacterial infections

BACKGROUND

Cutaneous nontuberculous mycobacterial infections result from external inoculation, spread of a deeper infection, or haematogenous spread of a disseminated infection. There are two species-specific infections (fish-tank or swimming-pool granuloma, due to Mycobacterium marinum, and Buruli ulcer, caused by M. ulcerans). Most infections, however, produce a nonspecific clinical picture.

OBJECTIVES

To define clinical patterns of cutaneous disease in nontuberculous mycobacterial infections.

METHODS

Fifty-one patients with cutaneous nontuberculous mycobacterial infections were reviewed. Clinical and histopathological features of normal hosts and immunosuppressed patients were compared. Two subgroups of immunosuppressed patients were distinguished: patients with cutaneous infection and patients with a disseminated infection and cutaneous involvement.

RESULTS

In immunosuppressed patients the number of lesions was significantly higher. Abscesses and ulceration were also more frequently observed. Different species were found in normal hosts and immunosuppressed patients. Several clinical patterns of cutaneous infection were defined: lymphocutaneous or sporotrichoid lesions; nonlymphocutaneous lesions at the site of trauma; folliculitis and furunculosis involving the lower extremities; disseminated lesions on the extremities in immunosuppressed patients. Two patterns were observed in patients with a disseminated infection: localized cutaneous lesions and disseminated cutaneous and mucosal lesions.

CONCLUSIONS

Cutaneous manifestations of nontuberculous mycobacterial infections may be classified according to criteria such as cutaneous lesions and immune status.

Vegetant bromoderma in an Infant

Bromoderma is a cutaneous reaction caused by the use of products containing bromide. In this report we describe a 2-month-old girl who was admitted to our institution with vegetative lesions on the face and scalp owing to the administration of a syrup containing sodium bromide.

Cutaneous infections due to nontuberculous mycobacteria: histopathological review of 28 cases. Comparative study between lesions observed in immunosuppressed patients and normal hosts

To evaluate the histopathological features observed in patients with cutaneous infections due to nontuberculous mycobacteria (NTM) and to compare the histopathological patterns observed in immunosuppressed patients and normal hosts. Twenty-eight biopsy specimens corresponding to 27 patients with cutaneous infections due to NTM were reviewed. Eighteen biopsies corresponded to normal hosts (14 Mycobacterium marinum, 2 Mycobacterium chelonae, 1 Mycobacterium terrae and 1 Mycobacterium gordonae) and 10 biopsy specimens were obtained from 9 immunosuppressed patients (3 Mycobacterium chelonae, one of which had two biopsies, 1 Mycobacterium abscessus, 2 Mycobacterium kansasii, 1 Mycobacterium marinum, 1 Mycobacterium avium complex and 1 Mycobacterium simiae). A panel of histopathological features was evaluated by two independent observers in each biopsy specimen. Epidermal changes (acanthosis, pseudoepitheliomatous hyperplasia, exocytosis) were mainly observed in M. marinum infections. In immunosuppressed patients the infiltrate tended to be deeper, involving the subcutaneous tissue (100%) with a more diffuse distribution and constant abscess formation. A marked granulomatous inflammatory reaction was observed in 83% of immunocompetent and in 60% of immunosuppressed patients. In immunosuppressed patients a relationship between the chronic evolution of the disease and granuloma formation was demonstrated. A diffuse infiltrate of histiocytes with occasionally foamy appearance was noted in three biopsy specimens from three patients with AIDS. Acute and chronic panniculitis was detected in 8 biopsy specimens. In one biopsy (M. chelonae) an acute suppurative folliculitis was observed. Different histopathological patterns can be noted in biopsy specimens from cutaneous nontuberculous mycobacterial infections. The evolution of the disease and the immunologic status of the host may explain this spectrum of morphological changes. Tuberculoid, palisading and sarcoid-like granulomas, a diffuse infiltrate of histiocytic foamy cells, acute and chronic panniculitis, non-specific chronic inflammation, cutaneous abscesses, suppurative granulomas and necrotizing folliculitis can be detected. Suppurative granulomas are the most characteristic feature in skin biopsy specimens from cutaneous NTM infections. Some histopathological patterns seem more prevalent in immunosuppressed patients.

Systemic lupus erythematosus presenting with red lunulae

Red lunulae have been observed in association with a large spectrum of cutaneous and systemic diseases. We describe a 13-year-old girl with painful red lunulae of the fingernails who subsequently developed systemic lupus erythematosus. The appearance of Beau's lines suggested inflammation of the nail matrix. Oral prednisone produced significant improvement in the nail changes. To our knowledge, red lunulae have not been previously recognized as the presenting sign of systemic lupus erythematosus.

Childhood sclerodermatomyositis: report of a case with the anti-PM/Scl antibody and mechanic's hands

We report a boy with overlap manifestations of systemic sclerosis and dermatomyositis (sclerodermatomyositis) whose disease showed a changing clinical pattern, and who had mechanic's hands, which are a cutaneous marker of myositis. Serological studies revealed antinuclear antibodies with a homogeneous nucleolar pattern. The anti-PM-Scl antibody was demonstrated by immunoblotting. HLA typing was positive for HLA-DR3/4. After a follow-up period of 11 years, no progression to severe systemic involvement was detected, and aggressive treatment was not administered. The recognition of subsets of patients with homogeneous clinical features and serological markers should permit the recognition of separate conditions among overlap syndromes. This would have prognostic and therapeutic implications.

Liquefactive panniculitis in the inguinal area as the first sign of chronic renal brucellosis

We describe an 82-year-old woman with an acute panniculitis in the left groin as the first sign of chronic renal brucellosis. She was afebrile and had a large erythematoviolaceous plaque with ulceration and liquefaction of the subcutaneous tissue. Histopathologic study showed a septal and lobular panniculitis with neutrophil infiltration, hemorrhage, and necrosis. Microbiologic cultures of a skin biopsy specimen, blood, and urine were negative. A computed tomography scan showed a left "mastic" kidney with a psoas abscess extending to the left inguinal region. The microbiologic culture of the removed renal mass and the serologic tests established the diagnosis of chronic renal brucellosis. Although the clinical picture of cold abscesses in the inguinal area classically suggests a tuberculosis, brucellosis should be included in the differential diagnosis.

Angiolymphoid hyperplasia with eosinophilia affecting the oral mucosa: report of a case and a review of the literature

Angiolymphoid hyperplasia with eosinophilia (ALHE) is an uncommon disorder of unknown aetiology. Clinically, it is characterized by cutaneous papules or nodules on the head and neck, and extracutaneous involvement is rare. We report a 30-year-old woman who had an asymptomatic submucosal nodule on the upper lip, which histopathologically showed features of ALHE, and review the previously described 15 cases of oral ALHE.

Kaposi's varicelliform eruption in a patient with healing second degree burns

A 15-year-old boy with Kaposi's varicelliform eruption complicating healing second degree burns is reported. Clinically, umbilicated vesicles and pustules evolving to extensive erosions appeared over previously burned areas, sparing normal skin. Rapid diagnosis was made on the basis of the presence of multinucleate giant cells in a Tzanck smear. Therapy with intravenous acyclovir was followed by complete epithelialization without scarring. Previous cases of Kaposi's varicelliform eruption in burned patients are reviewed.