RESUMEN
Introducción: El carcinoma basocelular (CBC) es una neoplasia maligna que deriva de queratinocitos localizados en la capa basal de la epidermis o en el epitelio folicular. La meta del tratamiento del carcinoma basocelular es erradicar el tumor de tal manera que la probabilidad de recurrencia sea la más baja posible. La prueba de Tzanck ha sido utilizada para el control de márgenes en la cirugía del CBC, por lo que el objetivo de este estudio es evaluar su efectividad en la población mexicana. Material y métodos: Se incluyeron 20 pacientes con diagnóstico clínico y dermoscópico de carcinoma basocelular con bordes bien delimitados, confirmados por histopatología. Después de extirpar el tumor con márgenes convencionales, se realizó raspado gentil con bisturí del nº 15 de los márgenes y lecho quirúrgico, que se extendió en laminillas de cristal, fueron teñidos con Giemsa y examinados. La efectividad de la prueba de Tzanck se realizó por comparación con la evaluación de la pieza quirúrgica por histopatología convencional. Resultados: La sensibilidad y especificidad de la prueba de Tzanck para control de márgenes fue de 87,5% (IC 95% 47,4, 99,7) y de 98,1% (IC 95%89,7, 99,9) respectivamente; mientras que los valores predictivo positivo, predictivo negativo y de exactitud diagnóstica fueron de 87,5% (IC 95%47,4, 99,7), 98,1% (IC 95% 89,7, 99,9) y de 96,6% (IC 95% 74,7, 99,9), respectivamente. Comentario: La efectividad demostrada de la prueba de Tzanck para control de márgenes es alentadora para desarrollar un abordaje alternativo práctico en el tratamiento del CBC bien delimitado (AU)
Introduction: Basal cell carcinoma (BCC) is a malignant neoplasm derived from keratinocytes that originate in the basal layer of the epidermis and the follicular epithelium. The goal in the treatment of BCC is complete tumor removal, so that the probability of recurrence may be the lowest possible. Tzancks test has been used for margin control in the surgery of BCC and the aim of this study is to evaluate its effectiveness in mexican population. Methods: Twenty patients with clinical and dermoscopical diagnosis of BCC were included, and confirmed by histopathology. After tumor extraction with conventional margins, the deep and lateral margins were gently scraped with a nº 15 scalpel to obtain smear materials that were spread ontomicroscopic slides, then dyed with giemsa stain and examined. The evaluation of Tzancks test effectiveness was made by comparison with the evaluation of the surgical specimen by conventional histopathology. Results: The sensitivity and specificity of Tzancks test for margin control were 87.5% (CI 95% 47.4, 99.7) and 98.1% (CI 95% 89.7, 99.9), respectively. Positive and negative predictive values and the diagnostic accuracy for Tzancks test were 87.5% (CI 95% 47.4, 99.7), 98.1% (CI 95% 89.7,99.9), and 96.6% (CI 95% 74.7, 99.9), respectively. Comments: The demonstrated effectiveness of Tzancks test for margin control is encouraging to develop a practical alternative approach for the treatment of well-demarcated BCC (AU)
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Carcinoma Basocelular/cirugía , Neoplasias Cutáneas/cirugía , Cirugía de Mohs/métodos , Invasividad Neoplásica/patología , Microcirugia/métodosRESUMEN
BACKGROUND: Chromoblastomycosis is a chronic subcutaneous mycosis that occurs more frequently in tropical and subtropical areas and is caused by a group of dematiaceous fungi. It is a difficult-to-treat mycosis with low cure rates and a high rate of relapses. OBJECTIVE: The objective of this trial is to prove the efficacy and tolerance of oral terbinafine in four cases of chromoblastomycosis. METHODS AND RESULTS: We included four cases of chromoblastomycosis, proved clinically and mycologically, that are presented herein; three of them caused by Fonsecaea pedrosoi and one by Phialophora verrucosa. Two had a small extension and the other two were of medium and large extension. Oral terbinafine was administered at a dose of 500 mg/day, which was reduced to half in two of the cases once an 80% improvement had been reached; in the third case the initial dose was maintained, and in the fourth case the dose was increased to 750 mg/day. Three cases reached clinical and mycological cure in a mean treatment period of 7 months, the fourth case reached a significant improvement only after 1.2 years of treatment. The medication was well tolerated; no liver alterations occurred; only one patient suffered mild dyspepsia. CONCLUSION: Terbinafine at 500 mg/day doses represents one of the best treatments for chromoblastomycosis due to its efficacy and excellent tolerability.