RESUMEN
BACKGROUND: Mohs micrographic surgery (MMS) is under used in the treatment of nail unit melanoma in situ (MIS), with limited studies in the literature. OBJECTIVE: Report clinical outcomes for nail unit MIS using MMS with melanoma antigen recognized by T cells-1 (MART-1) immunostaining. METHODS: A retrospective observational study at a single academic institution of patients with a diagnosis of nail unit MIS treated with MMS with MART-1 immunostaining from January 1, 2006, to December 30, 2016. The primary outcome measure was the recurrence rate after MMS. RESULTS: Fourteen patients were identified. With an average follow-up of 6.0 years (71.6 months; range = 5-139 months), 1 patient developed recurrence 6.6 years after undergoing initial MMS, requiring amputation with no further treatment or recurrence thereafter. CONCLUSION: Mohs micrographic surgery for nail unit MIS offers a high cure rate similar to other surgical modalities and can reduce the need for digital amputation. The evolution of the Mohs technique over time, namely, using MART-1 immunostaining, has led to improvement in treatment outcomes. Performing complete nail unit excision with nail plate remaining intact attached to the nail bed may also contribute to improved outcomes. Further refinement in technique and more data are necessary to continue to advance this treatment.
Asunto(s)
Carcinoma in Situ/cirugía , Melanoma/cirugía , Cirugía de Mohs/métodos , Enfermedades de la Uña/cirugía , Neoplasias Cutáneas/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Estudios RetrospectivosAsunto(s)
Fármacos Dermatológicos/uso terapéutico , Accesibilidad a los Servicios de Salud , Uso Fuera de lo Indicado/legislación & jurisprudencia , Enfermedades de la Piel/tratamiento farmacológico , United States Food and Drug Administration/legislación & jurisprudencia , Adulto , Niño , Dermatología , Aprobación de Drogas/legislación & jurisprudencia , Femenino , Humanos , Masculino , Evaluación de Necesidades , Enfermedades de la Piel/patología , Estados UnidosRESUMEN
Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) is a rare, severe mucocutaneous reaction with few large cohorts reported. This multicenter retrospective study included patients with SJS/TEN seen by inpatient consultative dermatologists at 18 academic medical centers in the United States. A total of 377 adult patients with SJS/TEN between January 1, 2000 and June 1, 2015 were entered, including 260 of 377 (69%) from 2010 onward. The most frequent cause of SJS/TEN was medication reaction in 338 of 377 (89.7%), most often to trimethoprim/sulfamethoxazole (89/338; 26.3%). Most patients were managed in an intensive care (100/368; 27.2%) or burn unit (151/368; 41.0%). Most received pharmacologic therapy (266/376; 70.7%) versus supportive care alone (110/376; 29.3%)-typically corticosteroids (113/266; 42.5%), intravenous immunoglobulin (94/266; 35.3%), or both therapies (54/266; 20.3%). Based on day 1 SCORTEN predicted mortality, approximately 78 in-hospital deaths were expected (77.7/368; 21%), but the observed mortality of 54 patients (54/368; 14.7%) was significantly lower (standardized mortality ratio = 0.70; 95% confidence interval = 0.58-0.79). Stratified by therapy received, the standardized mortality ratio was lowest among those receiving both steroids and intravenous immunoglobulin (standardized mortality ratio = 0.52; 95% confidence interval 0.21-0.79). This large cohort provides contemporary information regarding US patients with SJS/TEN. Mortality, although substantial, was significantly lower than predicted. Although the precise role of pharmacotherapy remains unclear, co-administration of corticosteroids and intravenous immunoglobulin, among other therapies, may warrant further study.
Asunto(s)
Corticoesteroides/uso terapéutico , Inmunoglobulinas Intravenosas/uso terapéutico , Síndrome de Stevens-Johnson/epidemiología , Sulfametoxazol/efectos adversos , Trimetoprim/efectos adversos , Adulto , Anciano , Estudios de Cohortes , Cuidados Críticos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Síndrome de Stevens-Johnson/tratamiento farmacológico , Síndrome de Stevens-Johnson/mortalidad , Análisis de Supervivencia , Estados Unidos/epidemiologíaRESUMEN
It is known that eosinophilic fasciitis can be associated with monoclonal gammopathy. There is clinical similarity between eosinophilic fasciitis and morphea profunda, but it is unclear whether morphea profunda might be associated with monoclonal gammopathy. The temporal quantification of gammopathy in morphea profunda has not been well characterized. We describe four patients with morphea profunda that were associated with monoclonal gammopathy. Three were associated with monoclonal IgG protein and one with IgM. No patients in our series developed myeloma. In conclusion, the association of monoclonal gammopathy is not unique to eosinophilic fasciitis and scleromyxedema. Further studies are necessary to characterize further the relationship between the two conditions.
Asunto(s)
Gammopatía Monoclonal de Relevancia Indeterminada/complicaciones , Esclerodermia Localizada/complicaciones , Adulto , Anciano , Femenino , Humanos , Inmunoglobulina G/inmunología , Inmunoglobulina M/inmunología , Masculino , Persona de Mediana Edad , Gammopatía Monoclonal de Relevancia Indeterminada/inmunología , Esclerodermia Localizada/patología , Piel/patologíaAsunto(s)
Actitud del Personal de Salud , Dermatología , Pediatría , Médicos/psicología , Pautas de la Práctica en Medicina/estadística & datos numéricos , Reumatología , Esclerodermia Localizada/terapia , Administración Cutánea , Corticoesteroides/administración & dosificación , Corticoesteroides/uso terapéutico , Adulto , Antibacterianos/uso terapéutico , Antimaláricos/uso terapéutico , Niño , Recolección de Datos , Humanos , Metotrexato/administración & dosificación , Metotrexato/uso terapéutico , Fototerapia , Práctica Profesional/estadística & datos numéricos , Muestreo , Esclerodermia Localizada/tratamiento farmacológico , Esclerodermia Localizada/psicologíaRESUMEN
Ethnomedical practices are increasing in all parts of the world, including many urban centers. We describe a unique case of a 7-year-old girl with atopic dermatitis who was responsive to parent-initiated treatment with the extract of a plant from the Chenopodium genus. A brief discussion raises awareness of such practices to the practicing dermatologist.
Asunto(s)
Chenopodium/química , Dermatitis Atópica/tratamiento farmacológico , Medicina Tradicional/métodos , Fitoterapia/métodos , Extractos Vegetales/uso terapéutico , Niño , Femenino , Humanos , Resultado del TratamientoRESUMEN
In this case report we describe an unusual appearance seen on a ventilation-perfusion (V/Q) scan in a woman with pulmonary hypertension. Although the pulmonary hypertension was not caused by pulmonary emboli, the V/Q scan suggested several cardiac anomalies which may lead to pulmonary hypertension. Most of the cardiac anomalies, including right-sided aortic arch and right-to-left shunt, can be deduced from careful examination of the V/Q scan. A subsequent cardiac MRI scan confirmed the anomalies.