Background Some studies have suggested a relationship between type 2 diabetes mellitus (T2DM) and increased incidence of melanoma. Efforts are under way to identify preventable and treatable factors associated with greater melanoma aggressiveness, but no studies to date have examined the relationship between T2DM and the aggressiveness of cutaneous melanoma at diagnosis. Objectives To explore potential associations between T2DM, glycaemic control and metformin treatment and the aggressiveness of cutaneous melanoma. Methods We conducted a cross-sectional multicentric study in 443 patients diagnosed with cutaneous melanoma. At diagnosis, all patients completed a standardized protocol, and a fasting blood sample was extracted to analyse their glucose levels, glycated haemoglobin concentration and markers of systemic inflammation. Melanoma characteristics and aggressiveness factors [Breslow thickness, ulceration, tumour mitotic rate (TMR), sentinel lymph node (SLN) involvement and tumour stage] were also recorded. Results The mean (SD) age of the patients was 55 center dot 98 (15 center dot 3) years and 50 center dot 6% were male. The median Breslow thickness was 0 center dot 85 mm. In total, 48 (10 center dot 8%) patients were diagnosed with T2DM and this finding was associated with a Breslow thickness > 2 mm [odds ratio (OR) 2 center dot 6, 95% confidence interval (CI) 1 center dot 4-4 center dot 9; P = 0 center dot 004)] and > 4 mm (OR 3 center dot 6, 95% CI 1 center dot 7-7 center dot 9; P = 0 center dot 001), TMR > 5 per mm(2) (OR 4 center dot 5, 95% CI 1 center dot 4-13 center dot 7; P = 0 center dot 009), SLN involvement (OR 2 center dot 3, 95% CI 1-5 center dot 7; P = 0 center dot 038) and tumour stages III-IV (vs. I-II) (OR 3 center dot 4, 95% CI 1 center dot 6-7 center dot 4; P = 0 center dot 002), after adjusting for age, sex, obesity, alcohol intake and smoking habits. No significant associations emerged between glycated haemoglobin levels, metformin treatment and melanoma aggressiveness. Conclusions T2DM, rather than glycaemic control and metformin treatment, is associated with increased cutaneous melanoma aggressiveness at diagnosis.

Acrylates are molecules that are well known for their strong sensitizing properties. Historically, many beauticians and individuals using store-bought artificial nail products have developed allergic contact dermatitis from acrylates. More recently, the use of acrylic nails among flamenco guitarists to strengthen their nails has become very popular. A 40-year-old non-atopic male patient working as a flamenco guitarist developed dystrophy, onycholysis and paronychia involving the first four nails of his right hand. The lesions were confined to the fingers where acrylic materials were used in order to strengthen his nails to play the guitar. He noticed improvement whenever he stopped using these materials and intense itching and worsening when he began reusing them. Patch tests were performed and positive results obtained with 2-hydroxyethyl methacrylate (2-HEMA), 2-hydroxyethyl acrylate (2-HEA), ethyleneglycol-dimethacrylate (EGDMA) and 2-hydroxypropyl methacrylate (2-HPMA). The patient was diagnosed with occupational allergic contact dermatitis likely caused by acrylic nails. Artificial nails can contain many kinds of acrylic monomers but most cases of contact dermatitis are induced by 2-HEMA, 2-HPMA and EGDMA. This is the first reported case of occupational allergic contact dermatitis from acrylates in artificial nails in a professional flamenco guitar player. Since the practice of self-applying acrylic nail products is becoming very popular within flamenco musicians, we believe that dermatology and occupational medicine specialists should be made aware of the potentially increasing risk of sensitization from acrylates in this setting.

The forehead flap continues to be one of the best options for the closure of surgical defects of the nasal pyramid larger than 2 cm. Adequate knowledge and careful application of the technique allows excellent results to be obtained with few complications.

IntroducciónEl Servicio de Dermatología del Hospital Universitario de Guadalajara es un centro de referencia en cirugía de Mohs, por lo que con cierta frecuencia nos vemos enfrentados al problema de la reconstrucción de defectos quirúrgicos nasales de gran tamaño. El colgajo frontonasal paramedial está considerado en la actualidad como una de las técnicas de elección en la reconstrucción de defectos nasales extensos.Material y métodosRevisamos nuestra experiencia en la reconstrucción nasal mediante el colgajo fronto-nasal paramediano entre los años 2004 y 2008. Describimos la técnica quirúrgica, las complicaciones y los resultados finales.ResultadosDiez pacientes con una media de edad de 75,1 años fueron reconstruidos mediante este colgajo. Un 20% requirió además injertos cartilaginosos y reconstrucción de la cobertura nasal interna. Las complicaciones más frecuentes fueron el sangrado (60%) y la necrosis parcial (10%). Los resultados finales, tanto estéticos como funcionales, fueron considerados buenos o excelentes en el 90% de los pacientes.ConclusionesEl colgajo fronto-nasal sigue siendo una de las mejores alternativas para el cierre de defectos quirúrgicos mayores de 2cm localizados en la pirámide nasal. El conocimiento de su técnica y su realización cuidadosa permite obtener excelentes resultados con pocas complicaciones.

Mohs micrographic surgery is a surgical technique that allows the excision in successive layers of cutaneous malignancies with the higher cure rates. At the same time, this surgical technique offers the maximal preservation of normal tissue. That is possible because Mohs surgery provides the advantage of microscopically controlled tumor-free borders in each stage guiding the surgeon in the tumor persistence until the complete surgical excision. Mohs micrographic surgery is a precise treatment for penile neoplasms and its utility is justified because the removal of a substantial surgical margin of normal tissue is obviated. MoHs micrographic surgery is indicated in the treatment of penile verrucous carcinoma due to the significant risk of loco-regional recurrence after conventional surgery. Although infrequent, other penile neoplasms that can benefit from Mohs micrographic surgery are: basal cell carcinoma, extrammamary Paget's disease, in situ melanoma and granular cell tumor.

La cirugía de Mohs es una técnica quirúrgica que permite la extirpación en capas de tumores cutáneos con los más elevados porcentajes de curación. Al mismo tiempo permite el máximo ahorro de tejido sano. Todo ello es posible gracias a la supervisión microscópica que posibilita analizar el 100% de los bordes tumorales de cada una de las capas y así poder guiar al cirujano en las sucesivas persistencias tumorales hasta la completa extirpación del tumor. La utilidad de la cirugía micrográfica de Mohs en el tratamiento de las neoplasias de pene tiene su justificación por el ahorro de tejido que permite. El carcinoma verrucoso de pene, constituye una indicación de cirugía de Mohs debido a la elevada tendencia a la recidiva local tras la cirugía convencional. Aunque más infrecuentes, otros tipos histológicos de tumores del pene en los que la cirugía micrográfica de Mohs puede ser de utilidad son: epitelioma basocelular, la enfermedad de Paget extramamaria, el melanoma in situ y el tumor de células granulosas.