Asunto(s)
Adenocarcinoma/complicaciones , Carcinoma Neuroendocrino/complicaciones , Neoplasias Pancreáticas/complicaciones , Paniculitis/patología , Adenocarcinoma/terapia , Anciano , Carcinoma Neuroendocrino/terapia , Resultado Fatal , Humanos , Masculino , Metástasis de la Neoplasia , Neoplasias Pancreáticas/terapia , Paniculitis/etiología , Paniculitis/terapia , Resultado del TratamientoRESUMEN
Clinical presentations of varicella-zoster virus (VZV) infection may vary widely among healthy and immunocompromised patients. In addition, the recurrence of VZV infection with cutaneous manifestations in both of these populations is more common than was once believed. Most cases of verrucous varicella infection have been reported in patients with documented immunosuppression (most commonly HIV/AIDS). We present an unusual case of persistent verrucous varicella, which was the initial manifestation of HIV infection, in a previously "healthy" 3-year-old girl with a strong family history of Wiskott-Aldrich Syndrome. Current research, therapeutic options, and differential diagnoses with regard to VZV infection are briefly reviewed.
Asunto(s)
Infecciones por VIH/diagnóstico , Herpes Zóster/diagnóstico , Herpes Zóster/inmunología , Herpesvirus Humano 3/aislamiento & purificación , Huésped Inmunocomprometido , Aciclovir/administración & dosificación , Antivirales/administración & dosificación , Preescolar , Enfermedad Crónica , Femenino , Estudios de Seguimiento , Infecciones por VIH/inmunología , Seropositividad para VIH , Herpes Zóster/tratamiento farmacológico , Humanos , Medición de Riesgo , Resultado del TratamientoRESUMEN
BACKGROUND: Profound central-retinal visual losses have been a major presenting factor reported in cancer and melanoma associated retinopathies (CAR, MAR). However, it is well established that standardised tests of peripheral retinal function are often the most sensitive detectors of early eye disease. This is a preliminary investigation of the responsiveness of the peripheral retina to "distant" (non-eye or CNS) cancers using easily obtained standardised tests. METHODS: The design is a single blind study where test results are compared with published norms and a small age matched control group. Of 120 ambulatory cancer outpatients who were interviewed at routine follow up examinations, 111 volunteered and admitted a range of mild visual changes. 25 cancer patients completed all tests of peripheral vision function and a clinical screening. There were seven control subjects of the same age range. RESULTS: 98% (49 of 50) of eyes from the patient cohort were judged clinically normal following examinations which emphasised the central retina, fundus appearance, and static fields. On testing which emphasised the visual periphery, 46 (92%) eyes showed one or more quantitative abnormalities >2 SD from the age adjusted norm means. These abnormalities clustered mainly about dark adaptation (rod cell) sensitivity (31, 62% of measured sites), the blue sensitive retinal cells (17, 34% of measured eyes), and the oscillatory component (OP) of the electroretinogram (23, 46% of measured eyes). One control eye (7%) showed a significant dark adaptation abnormality and ERG reduction. There was no identifiable interaction between chemotherapy mode and the cancer associated retinal deficits (CARD). Antiretinal antibodies were found in sera from most patients and controls. CONCLUSION: CARD is common in the retinal periphery of many cancer patients, and is distinct from rare CAR, MAR central-retinal responses. CARD has numerous potential clinical uses which justify expanded research with more defined large samples.
Asunto(s)
Neoplasias de la Mama/complicaciones , Neoplasias Pulmonares/complicaciones , Melanoma/complicaciones , Baja Visión/etiología , Adaptación Ocular/fisiología , Adulto , Anciano , Análisis de Varianza , Antineoplásicos/uso terapéutico , Autoanticuerpos/sangre , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/inmunología , Estudios de Casos y Controles , Pruebas de Percepción de Colores , Electrorretinografía , Femenino , Humanos , Neoplasias Pulmonares/tratamiento farmacológico , Neoplasias Pulmonares/inmunología , Masculino , Melanoma/tratamiento farmacológico , Melanoma/inmunología , Persona de Mediana Edad , Valores de Referencia , Retina/inmunología , Método Simple Ciego , Baja Visión/diagnóstico , Agudeza Visual , Pruebas del Campo VisualAsunto(s)
Adenocarcinoma Mucinoso/diagnóstico , Neoplasias de los Párpados/diagnóstico , Neoplasias de las Glándulas Sudoríparas/diagnóstico , Adenocarcinoma Mucinoso/patología , Adenocarcinoma Mucinoso/cirugía , Diagnóstico Diferencial , Glándulas Ecrinas , Neoplasias de los Párpados/patología , Neoplasias de los Párpados/cirugía , Humanos , Masculino , Persona de Mediana Edad , Cirugía de Mohs , Neoplasias de las Glándulas Sudoríparas/patología , Neoplasias de las Glándulas Sudoríparas/cirugíaRESUMEN
We present the first reported cases of tinea nigra treated with terbinafine. Two cases responded to treatment with topical terbinafine; one case failed to respond to treatment with systemic terbinafine.
Asunto(s)
Antifúngicos/uso terapéutico , Naftalenos/uso terapéutico , Tiña del Pie/tratamiento farmacológico , Administración Tópica , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , TerbinafinaRESUMEN
PURPOSE: To address outcomes in clinically asymptomatic patients in whom the unexpected finding of microscopic perineural invasion is noted at the time of surgery. METHODS AND MATERIALS: The 35 patients included in this study had skin cancers of the head and neck treated with curative intent between January 1965 and April 1995 at the University of Florida. All patients were without clinical or radiographic evidence of perineural invasion but, at the time of biopsy or surgical excision, had the incidental finding of microscopic perineural invasion. Definitive therapy consisted of radiotherapy alone after lesion biopsy (3 patients) or surgical excision preceded (2 patients) or followed (30 patients) by radiotherapy. All patients had follow-up for at least 1 year, 13 patients (37%) had follow-up for at least 5 years. RESULTS: The 5-year local control rate was 78%. The 5-year local control rate for the few patients treated with radiotherapy alone was statistically similar to that for patients treated with surgery and radiotherapy (100% vs. 77%, p = 0.4). Multivariate analysis for factors affecting local control included sex, histology, age, treatment group, clinical T stage, initial histologic differentiation, and previously untreated vs. recurrent tumors, none of which was found to be significant. CONCLUSIONS: Both surgery plus radiotherapy and radiotherapy alone provide a relatively high rate of local control for patients with incidentally discovered perineural invasion secondary to skin cancer.
Asunto(s)
Carcinoma Basocelular/patología , Carcinoma de Células Escamosas/patología , Neoplasias de Cabeza y Cuello/patología , Neoplasias del Sistema Nervioso Periférico/patología , Neoplasias Cutáneas/patología , Adulto , Anciano , Anciano de 80 o más Años , Análisis de Varianza , Biopsia , Carcinoma Basocelular/mortalidad , Carcinoma Basocelular/radioterapia , Carcinoma Basocelular/cirugía , Carcinoma de Células Escamosas/mortalidad , Carcinoma de Células Escamosas/radioterapia , Carcinoma de Células Escamosas/cirugía , Terapia Combinada , Femenino , Estudios de Seguimiento , Neoplasias de Cabeza y Cuello/mortalidad , Neoplasias de Cabeza y Cuello/radioterapia , Neoplasias de Cabeza y Cuello/cirugía , Humanos , Masculino , Persona de Mediana Edad , Invasividad Neoplásica , Recurrencia Local de Neoplasia , Estadificación de Neoplasias , Neoplasias Cutáneas/mortalidad , Neoplasias Cutáneas/radioterapia , Neoplasias Cutáneas/cirugía , Insuficiencia del TratamientoRESUMEN
Cutaneous hypersensitivity reactions to vitamin K are rare. They occur almost exclusively with fat-soluble vitamin K (K1). The lesion is most commonly a pruritic, indurated plaque at the site where the vitamin was injected. Most plaques resolve within 4 to 8 week without sequelae, but some progress to produce scar-like changes that may last for years.
Asunto(s)
Hipersensibilidad a las Drogas/etiología , Vitamina K/efectos adversos , Adulto , Biopsia , Trastornos de la Coagulación Sanguínea/tratamiento farmacológico , Hipersensibilidad a las Drogas/patología , Eritema/patología , Femenino , HumanosRESUMEN
BACKGROUND: Controversy over the rate of malignant transformation of actinic keratosis (AK) into cutaneous squamous cell carcinoma (SCC) has generated considerable debate regarding the importance of treating all such precancers to preclude their transofrmation. Current changes in US healthcare policy will deny many individuals access to certain simple and effective treatment modalities for precancerous lesions. OBJECTIVE: Our purpose was to determine whether there is a significant association between the presence of cutaneous SCC and pre-existing AK. METHODS: One hundred and sixty five consecutive cases of cutaneous SCC, retrieved from the files of a university-affiliated dermatopathology laboratory serving north-central Florida, were selected for review by a single dermatopathologist (D.M.). Hematoxylin and eosin stained skin tissue slides were examined under light microscopy for the presence of AK in close proximity to, or giving rise to, cutaneous SCC. RESULTS: Of the 165 cutaneous SCC cases reviewed, 82.4% (136 out of 165) were found to have concomitant AK giving rise to and/or in close proximity to SCC. Of the 136 AK-positive SCC cases, 26.7% (44) were identified as superficial SCC arising within an AK (AKSSCC) and 55.7% (92) had AK in close proximity to SCC (AK + SCC). Close proximity is defined to include AK changes located directly adjacent to (on the shoulder of) SCC, to a maximum distance of 8 mm away. CONCLUSIONS: The 82.4% prevalence of concomitant AK and cutaneous SCC in our biopsy population suggests a strong correlation between these two lesions. The fact that 26.7% of these lesions had SCC arising from AK highlights the importance of early recognition and effective treatment for AK.
Asunto(s)
Carcinoma de Células Escamosas/patología , Queratosis/patología , Lesiones Precancerosas/patología , Neoplasias Cutáneas/patología , Biopsia , Carcinoma in Situ/patología , Humanos , Piel/patologíaRESUMEN
Nonmelanoma skin cancers encompass a vast array of malignancies: adventitial, vascular, neuroendocrine, hematologic, adnexal, and epithelial. The skin is also a major site for metastasis of internal disease. With an understanding of the frequency of presentation, clinical distribution, and appearance, the clinician is able to provide an accurate diagnosis for most lesions. Because there are so many nonmelanoma skin cancers, the focus here is on those with a high frequency or significant morbidity. The treatment of nonmelanoma skin cancer is constantly evolving; therefore, emphasis is on diagnosis.
Asunto(s)
Neoplasias Cutáneas/diagnóstico , Adenocarcinoma Sebáceo/diagnóstico , Carcinoma Basocelular/diagnóstico , Carcinoma Basocelular/cirugía , Carcinoma de Células de Merkel/diagnóstico , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/cirugía , Dermatofibrosarcoma/diagnóstico , Humanos , Queratoacantoma/diagnóstico , Enfermedad de Paget Extramamaria/diagnóstico , Enfermedades de la Piel/diagnóstico , Neoplasias Cutáneas/patología , Neoplasias Cutáneas/secundario , Neoplasias Cutáneas/terapiaAsunto(s)
Neoplasias de la Mama Masculina/complicaciones , Neurofibromatosis 1/complicaciones , Enfermedad de Paget Mamaria/complicaciones , Anciano , Axila , Biopsia , Neoplasias de la Mama Masculina/patología , Neoplasias de la Mama Masculina/cirugía , Diagnóstico Diferencial , Humanos , Escisión del Ganglio Linfático , Masculino , Mastectomía Radical , Enfermedad de Paget Mamaria/patología , Enfermedad de Paget Mamaria/cirugíaAsunto(s)
Enfermedades de la Piel/patología , Anciano , Atrofia/tratamiento farmacológico , Atrofia/patología , Biopsia , Enfermedad Crónica , Diagnóstico Diferencial , Epidermis/ultraestructura , Humanos , Masculino , Microscopía Electrónica , Esclerosis/tratamiento farmacológico , Esclerosis/patología , Enfermedades de la Piel/tratamiento farmacológicoRESUMEN
Patients often present to their primary care physicians for removal of skin lesions for diagnosis or to improve cosmesis. Often, the lesions are located on areas of the body where the skin does not provide a great deal of laxity, such as the face and extremities. Thus, closure of the secondary defect resulting from removal of the lesion is difficult. A simple technique that utilizes subcutaneous island pedicle flaps may be used in such situations. Subcutaneous island pedicle flaps facilitate closure of wounds and avoid complications often encountered with the use of alternative techniques such as rotation flaps, transposition flaps and skin grafts.
Asunto(s)
Colgajos Quirúrgicos/métodos , Humanos , Colgajos Quirúrgicos/efectos adversosRESUMEN
Skin undergoes numerous macroscopic changes during the aging process. These alterations in the skin result from both intrinsic changes to the cells and connective tissue of the skin that are inherent with the chronologic aging of the individual and changes as a result of environmental insults to the organ, particularly ultraviolet irradiation. The combination of these factors produces a tissue which possesses quite different attributes compared with the skin of a young individual and which may result in characteristic lesions, both malignant and benign. Understanding these changes and the underlying mechanisms for them will help to treat older individuals in whom specific lesions develop as well as help to prevent the occurrence of these pathologic conditions.
RESUMEN
A 5-month-old boy with erythrokeratoderma variabilis is presented. The parents noted that the asymptomatic erythematous plaques changed over the course of hours to days. Topical therapy with retinoic acid proved ineffective. A brief review of the literature is presented.
Asunto(s)
Enfermedades de la Piel/tratamiento farmacológico , Triamcinolona/uso terapéutico , Administración Tópica , Aberraciones Cromosómicas , Trastornos de los Cromosomas , Cromosomas Humanos Par 1 , Humanos , Lactante , Masculino , Enfermedades de la Piel/diagnóstico , Enfermedades de la Piel/genética , Triamcinolona/administración & dosificaciónRESUMEN
Multiple endocrine neoplasia type 2B/3 is characterized by multiple mucosal neuromas, a marfanoid appearance, medullary thyroid carcinoma, pheochromocytoma, gastrointestinal ganglioneuromatosis, and thickened corneal nerves. This rare syndrome is inherited in an autosomal dominant pattern. Early recognition followed by appropriate screening and treatment can be life-saving.
Asunto(s)
Neoplasia Endocrina Múltiple Tipo 2b/genética , Neoplasias de las Glándulas Suprarrenales/genética , Neoplasias de las Glándulas Suprarrenales/patología , Carcinoma/genética , Carcinoma/patología , Córnea/inervación , Ganglioneuroma/genética , Ganglioneuroma/patología , Neoplasias Gastrointestinales/genética , Neoplasias Gastrointestinales/patología , Humanos , Síndrome de Marfan/patología , Neoplasia Endocrina Múltiple Tipo 2b/diagnóstico , Neoplasia Endocrina Múltiple Tipo 2b/patología , Neuroma/genética , Neuroma/patología , Feocromocitoma/genética , Feocromocitoma/patología , Neoplasias de la Tiroides/genética , Neoplasias de la Tiroides/patologíaRESUMEN
A patient with multiple actinic keratoses was treated with the standard regimen of 5 percent fluorouracil cream. The patient noted bilateral ectropion within two weeks of receiving therapy. The ectropion completely resolved with discontinuation of therapy. This is the first reported case of transient ectropion associated with 5-fluorouracil therapy.
Asunto(s)
Ectropión/inducido químicamente , Fluorouracilo/efectos adversos , Administración Cutánea , Anciano , Dermatosis Facial/tratamiento farmacológico , Fluorouracilo/administración & dosificación , Humanos , Queratosis/tratamiento farmacológico , MasculinoRESUMEN
Although squamous cell carcinoma of the skin is still less common than basal cell carcinoma, its incidence is increasing at an alarming rate. Cumulative sun exposure is a major risk factor, and deterioration of the ozone layer combined with life-style choices that promote time in the sun may account for part of the increased incidence. Other risk factors for squamous cell carcinoma include exposure to ionizing radiation, arsenic, or industrial chemicals; viral infection; preexisting burns and scars; and immunosuppression. Actinic keratosis is considered a precancerous lesion that should be watched closely. Treatment methods for squamous cell carcinoma vary depending on the size and location of the lesion. Knowledge of high-risk locations and appropriate treatment choices ensures proper care and decreases the likelihood of metastasis.