Introduction: Complete lymph node dissection (CLND) was the standard practice for patients with melanoma and a positive sentinel lymph node biopsy (SLNB) until the results of two clinical trials published in 2016 and 2017 demonstrated that it did not improve melanoma-specific survival (MSS). However, it continues to be performed in some scenarios. No studies have ever been published on lymph node management after a positive SLNB in the routine clinical practice in our setting. Objectives: To determine the evolution of the indication for CLND in patients with a positive SLNB, as well as the characteristics associated with its performance. Material and methods: We conducted a multicenter retrospective observational study with patients with skin melanoma and positive sentinel lymph nodes diagnosed from 2017 through 2022 at 8 Spanish centers and 1 Italian center. Results: A total of 430 patients were included, 54% men, with 323 (75.1%) aged between 45 and 80 years. A total of 133 cases (31%) exhibited Breslow thickness >4 mm, 206 cases (49%) were ulcerated, and in 213 cases (55.7%), lymph node metastasis was >1 mm. Isolated lymphadenectomy or followed by adjuvant therapy was performed in 146 patients (34.1%). After multivariate logistic regression, the factors associated with the performance of CLND were the acral lentiginous melanoma histological subtype, lymph node metastasis size >1 mm, extracapsular spread, and the participant hospital. Age >80 years was inversely associated. Conclusion: While the frequency of CLND in patients with melanoma and positive SLNB has decreased, the indication for systemic adjuvant therapy in these patients has increased. However, CLND is still indicated in patients with high-risk characteristics. (c) 2024 AEDV. Published by Elsevier Espana, S.L.U. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Cutaneous squamous cell carcinoma (cSCC) is the second most common skin cancer and, when unresectable, presents a therapeutic challenge. This study retrospectively analysed five multi-morbid patients with unresectable cSCC, some with multiple lesions, treated using CO2 laser vaporization followed by intralesional 5-fluorouracil (5-FU) infiltration. All patients showed positive responses: two achieved complete clinical resolution, and three showed significant tumor reduction. No adverse effects were reported, and no local recurrences were observed at six months in those with resolved lesions. The combination of CO2 laser and 5-FU, not previously reported, may represent a promising palliative option for selected patients with unresectable cSCC. Further studies are needed to validate its efficacy.

Introducción: El melanoma presenta una incidencia creciente en España. Los estadios pronósticos de los pacientes con melanoma son determinados por diversos factores biológicos, como el grosor del tumor, la ulceración o la presencia de metástasis regionales o a distancia. La Academia Española de Dermatología y Venereología (AEDV) ha impulsado la creación de un Registro Español de Melanoma (REGESMEL) con el fin de evaluar otros factores de índole individual y relacionados con el Sistema Sanitario que pudieran influir en el pronóstico de los pacientes con melanoma. El objetivo del presente artículo es presentar REGESMEL y proporcionar datos descriptivos básicos correspondientes a su primer año de funcionamiento.Métodos: REGESMEL es una cohorte prospectiva multicéntrica de pacientes consecutivos con melanoma cutáneo invasivo que recoge datos demográficos y de estadificación, así como datos basales individuales y relacionados con la atención sanitaria. También registra el tratamiento médico y quirúrgico recibido.Resultados: Se incluyeron 450 casos de melanoma cutáneo invasivo procedentes de 19 centros participantes, detectando un predominio de melanomas finos con un grosor ≤1 mm (54,7%), localizados principalmente en el tronco posterior (35,2%). La biopsia selectiva del ganglio centinela se realizó en el 40,7% los casos. La mayoría de los casos de melanoma fueron sospechados por el propio paciente (30,4%) o por dermatólogos (29,6%). Los pacientes recibieron atención principalmente en centros sanitarios públicos (85,2%), empleándose algún recurso de teledermatología en el 21,6% de los casos.Conclusiones: La distribución de las variables patológicas y demográficas de los casos es consistente con los datos de otros estudios. REGESMEL cuenta ya con casos de 15 provincias españolas y dada su potencial representatividad convierte al Registro en una herramienta de importancia para abordar una amplia gama de preguntas de investigación.

Familial melanoma is defined as melanoma occurring in two or more first-degree relatives by the WHO. Germline mutations are isolated in a subset of them. It is well known that CDKN2A is the most frequently mutated high-risk gene in familial melanoma, however, the prognosis it confers to patients who carry its mutations is still controversial. This review aims to assess whether germline mutations imply a worse prognosis in patients with familial melanoma. A systematic review and meta-analysis were conducted by searching the electronic databases PubMed/MEDLINE, EMBASE, and Cochrane Library. Data from 3 independent populations were eventually included in the meta-analysis, involving 291 cases and 57 416 controls. The results of this systematic review and meta-analysis suggest that there is a tendency for patients with germline mutations in the CDKN2A gene to have a worse overall survival (HR = 1.30, 95% CI = 0.99-1.69, P  = 0.05) and melanoma-specific survival (HR = 1.5, 95% CI = 0.97-2.31, P  = 0.07). Carrier patients would not only have more incidence of melanoma and a higher risk of a second melanoma, but they also seem to have a worse prognosis. The inclusion of gene panel testing in clinical practice and the collaboration within consortia are needed to provide further evidence on the prognosis of these patients.

Introducción La disección ganglionar completa (DGC) era la práctica estándar en pacientes con melanoma y biopsia selectiva del ganglio centinela (BSGC) positiva hasta que, en 2016 y 2017 se publicaron los resultados de dos ensayos clínicos que no demostraron que mejorase la supervivencia específica por melanoma (SEM). Sin embargo, continúa realizándose en algunos escenarios. No existen estudios que recojan el manejo ganglionar tras BSGC positivo en la práctica clínica en nuestro medio. Objetivos Determinar la evolución de la indicación de la DGC en pacientes con BSGC positiva, así como las características que se asocian a su realización. Material y métodos Estudio observacional retrospectivo multicéntrico que incluye pacientes con melanoma cutáneo y ganglio centinela positivo diagnosticados entre los años 2017-2022 en ocho centros españoles y uno italiano. Resultados Se incluyeron 430 pacientes, 54% hombres, 358 (75,1%) tenían entre 45-80 años, de ellos, 133 casos (31%) presentaban un Breslow>4mm, 206 casos (49,1%) estaban ulcerados, en 213 casos (55,7%) la metástasis ganglionar era>1mm. Se realizó la linfadenectomía aislada o seguida de adyuvancia en 146 pacientes (34,1%). Tras una regresión logística multivariante, los factores asociados a la realización de DGC fueron el subtipo histológico melanoma lentiginoso acral (MLA), un tamaño de metástasis ganglionar>1mm, la extensión extracapsular y el hospital participante. La edad>80 años se asoció inversamente. Conclusión Mientras que ha disminuido la frecuencia de realización de la DGC en pacientes con melanoma y BSGC positiva, ha aumentado la indicación del tratamiento sistémico adyuvante en estos pacientes. Sin embargo, se sigue indicando la DGC en pacientes con características de alto riesgo.

Taibo, Ana MD*; González, Álvaro González MD*; Paradela, Sabela MD PhD*; del Pozo Losada, Jesús MD PhD Author Information

The aim of this study was to evaluate response and drug survival of biologic therapy in patients with moderate to severe plaque-type psoriasis who initiated biologic therapy at least 10 years ago, in a real-world setting. This was an observational retrospective follow-up study that included patients with moderate to severe plaque-type psoriasis who initiated biologic therapy between October 2006 and December 2009. Efficacy was expressed as the percentage of patients achieving a 50, 75 and 90% reduction from baseline in the Psoriasis Area and Severity Index (PASI 50, PASI 75, PASI 90, respectively) every 3 months during the first year of therapy and then every 12 months up to the end of follow-up or withdrawal from the study. A total of 56 patients were included in the study, representing 140 treatment lines (median 2, range 1–8); of these patients, 53 were still receiving biologic therapy at the end of the study. The mean duration of biologic therapy was 140.4 (range 47.6–175.4) months. Etanercept was used in 98.2% of patients, followed by efalizumab (42.9%), adalimumab (41.1%), ustekinumab (33.9%) and infliximab (16.1%). Treatment lines were switched in 62.1% of treatments: 24.3% due to secondary failure, 20.7% due to primary failure and 3.6% due to side effects. No patient treated with anti-interleukins had to discontinue treatment due to side effects. Ustekinumab had the highest drug survival. This study in the real-world-setting shows maintenance of long-term efficacy and safety of biologic therapy in patients with moderate to severe plaque psoriasis in daily practice who initiated biologic therapy 10 years ago.

Goltz syndrome is an X-linked dominant, multisystem birth defect due to PORCN mutation. The skin findings follow Blaschko's lines and often show epidermal atrophy and herniation of subcutaneous fatty tissue. Regarding treatment, light sources can offer a good therapeutic option for some manifestations of this rare disease and improve the aesthetic appearance of the skin lesions. We report two new cases of Goltz syndrome in which the cutaneous findings remarkably improved with pulsed dye laser and carbon dioxide laser.

The therapeutic value of sentinel lymph node biopsy (SLNB) in thin melanoma remains controversial. The aim of this study is to determine the role of SLNB in the survival of thin melanomas (≤1 mm). A multicenter retrospective observational study was designed. A propensity score matching was performed to compare patients who underwent SLNB vs. observation. A multivariate Cox regression was used. A total of 1438 patients were matched by propensity score. There were no significant differences in melanoma-specific survival (MSS) between the SLNB and observation groups. Predictors of MSS in the multivariate model were age, tumor thickness, ulceration, and interferon treatment. Results were similar for disease-free survival and overall survival. The 5- and 10-year MSS rates for SLN-negative and -positive patients were 98.5% vs. 77.3% (p < 0.001) and 97.3% vs. 68.7% (p < 0.001), respectively. SLNB does not improve MSS in patients with thin melanoma. It also had no impact on DSF or OS. However, a considerable difference in MSS, DFS, and OS between SLN-positive and -negative patients exists, confirming its value as a prognostic procedure and therefore we recommend discussing the option of SLNB with patients.

The aim of this study was to compare tumour burden in patients who underwent surgery for melanoma and cutaneous squamous cell carcinoma during nationwide lockdown in Spain due to COVID-19 (for the period 14 March to 13 June 2020) and during the same dates in 2019 before the COVID-19 pandemic. In addition, associations between median tumour burden (Breslow thickness for melanoma and maximum clinical diameter for cutaneous squamous cell carcinoma) and demographic, clinical, and medical factors were analysed, building a multivariate linear regression model. During the 3 months of lockdown, there was a significant decrease in skin tumours operated on (41% decrease for melanoma (n = 352 vs n = 207) and 44% decrease for cutaneous squamous cell carcinoma (n = 770 vs n = 429)) compared with the previous year. The proportion of large skin tumours operated on increased. Fear of SARS-CoV-2 infection, with respect to family member/close contact, and detection of the lesion by the patient or doctor, were related to thicker melanomas; and fear of being diagnosed with cancer, and detection of the lesion by the patient or relatives, were related to larger size cutaneous squamous cell carcinoma. In conclusion, lockdown due to COVID-19 has resulted in a reduction in treatment of skin cancer.

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Background Cutaneous lupus erythematosus is a chronic autoimmune disease that can leave important sequelae. Objective To determine the factors that predict the activity and damage of the skin disease, and the impact of tobacco on the efficacy of antimalarials using the Cutaneous Lupus Erythematosus Disease Area and Severity Index. Materials and Methods A consecutive case series was performed on 260 patients with cutaneous lupus erythematosus (α = 0.05; precision ± 6.5%). We carried out a descriptive analysis of the variables included, with a multivariate analysis to measure the association of variables with the Cutaneous Lupus Erythematosus Disease Area and Severity Index activity and damage ( p value < 0.05). Results The Cutaneous Lupus Erythematosus Disease Area and Severity Index activity was greater in smokers than non-smokers (4.0 ±5.3 vs 1.2 ±3.4, p = 0.006). No significant differences were observed in the Cutaneous Lupus Erythematosus Disease Area and Severity Index activity when the efficacy of antimalarials was analyzed between smokers and non-smokers. Cutaneous Lupus Erythematosus Disease Area and Severity Index damage was higher in smokers than in non-smokers (2.0 ± 3.6 vs 1.2 ± 2.6, p = 0.029). Cutaneous Lupus Erythematosus Disease Area and Severity Index activity was associated with: (a) being an active smoker (odds ratio 3.04, 95% confidence interval 1.68–5.51, p < 0.001; regression coefficient 2.05, 95% confidence interval 0.69–3.42, p = 0.003); (b) the chronic cutaneous lupus erythematosus subtype (odds ratio 1.98, 95% confidence interval 1.02–3.84, p = 0.044); and (c) C-reactive protein increase (≥0.5 mg/dL) (regression coefficient 2.56, 95% confidence interval 0.40–4.71, p = 0.020). Cutaneous Lupus Erythematosus Disease Area and Severity Index damage was associated with: (a) the activity (regression coefficient 0.11, 95% confidence interval 0.01–0.20, p = 0.024); (b) the chronic cutaneous lupus erythematosus subtype (regression coefficient 2.46, 95% confidence interval 1.37–3.56, p < 0.001); (c) the use of topical treatment (regression coefficient 1.31, 95% confidence interval 0.01–2.61, p = 0.049); and (d) systemic treatment (regression coefficient 1.44, 95% confidence interval 0.35–2.53, p < 0.010). Conclusion Smoking is related to an increase risk and a greater activity of cutaneous lupus erythematosus. The chronic cutaneous lupus erythematosus subtype and an increased C-reactive protein level were also associated with a higher disease activity. The sequelae were related to the activity, the chronic cutaneous lupus erythematosus subtype, and the use of topical and systemic treatment. The impact of tobacco on the efficacy of antimalarials may be caused by an increase in the severity of the disease more than by resistance in smokers.

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Actinic cheilitis (AC) is a chronic condition that affects mainly the lower lip. To investigate the use of lip photopro-tection in patients with AC. A cross-sectional multicentre study of patients, =45 years of age, was performed in eight dermatology departments in the Galicia region over a period of one year. From 1,239 patients included in the study, 410 were diagnosed with AC and complete data were available for 408. An analysis of lip photopro-tection habits and possible associations in patients with AC is reported. Mean age of patients with AC was 71.9 years and 53.8% were women. More than 90% of AC patients (370/408) had never used lip photoprotection. In the group of patients who used it, 62.16% of them had only used a single stick within the previous year. The only variable significantly associated with the use of lip sun protection was low Fitzpatrick’s skin types I and II (p=0.039). Study limitations include the inclusion of patients 45 years or older and the use of a semiquantitative scale for measuring the frequency of application of lip photoprotection. To our knowledge, this is the first European study focused on lip photoprotection in patients suffering from AC. Only a minority of AC patients protect their lips from UV radiation. Specific lip sun protection recommendations should be promoted, especially in high-risk populations.

Background: Efficacy and safety profiles of ustekinumab have been proved in numerous clinical trials. However, relevant variations with daily practice have been shown and few studies value the long-term response maintenance. Objective: To evaluate the efficacy of long-term ustekinumab therapy in patients with moderate-to-severe plaque-type psoriasis in a real-world setting. Methods: Observational retrospective follow-up study including, patients receiving ustekinumab at least 3 months in our department. Efficacy was expressed as percentage of patients achieving Psoriasis area and severity index (PASI) 50, PASI75, and PASI90 and maintaining PASI <= 5, <= 3, and 0 every 3 months during the first year of treatment, and every 12 months to the end of follow-up or to withdrawal from the study. Results: Sixty-one patients. Fifty patients had previously been treated with other biologic therapies. The percentage of patients maintaining PASI90 was 72.1, 78.3, 70.0, 83.3, 96.2, 91.7, and 100.0%, and PASI value maintained 0 in 68.9, 73.9, 67.50, 80.6, 96.2, 91.7, and 100.0% at 3, 12, 24, 36, 60, 84, and 96 months. Ustekinumab was discontinued in 26.2% of patients. No patients were withdrawn because of adverse events. Conclusions: This real world-setting study shows maintenance of long-term efficacy and safety of ustekinumab treatment in moderate-severe plaque psoriasis in daily practice through 8 years.

BACKGROUND/OBJECTIVES:Atypical fibroxanthoma (AFX) is a mesenchymal neoplasm of unknown incidence. It has been determined that AFX is a tumour with low aggressiveness as long as it is properly diagnosed. Our objectives were to exclude pleomorphic dermal sarcomas or other skin tumours incorrectly diagnosed as AFX in our centre after applying strict diagnostic criteria and to assess the behaviour of appropriately diagnosed AFX.METHODS:We conducted an observational retrospective analysis of 73 patients diagnosed with AFX in our centre between 1998 and 2018. After selecting cases fulfilling AFX criteria, we made an analysis of predictive factors for local recurrence. Crude and sex-adjusted incidence rates were calculated.RESULTS:Out of 73 cases, 62 were eventually diagnosed as AFX. We examined for absence of tumour necrosis, lymphovascular or perineural invasion and infiltration of deep structures. Cytokeratin AE1-AE3, desmin and CD34 were negative in all cases. The remaining tumours were reclassified. The incidence of AFX in our health-care area was estimated at 0.59 cases every 100 000 inhabitants per year. In our series, 72.6% of the patients were men with mean age at diagnosis of 81 years. Average tumour diameter was 12 mm. The most common location was head and neck (96.8%). Only four local recurrences were detected over a mean of 47-month follow-up.CONCLUSIONS:We report a series of AFX in our health-care area. We verify its indolent course when it is properly diagnosed.

Cutaneous melanoma (CM) causes more deaths than any other skin tumor, and incidence and mortality rates have risen in recent years, especially in patients of advanced age. There are differences in the biological behavior of CM tumors in the elderly as well as differential management of the disease, evidently influenced by such factors as limited life expectancy, the high incidence of concomitant conditions in older patients, and issues of quality of life unrelated to CM itself. We review relevant current literature on the epidemiology, etiology, pathogenesis, and immunology of CM as well as research on the clinical features, prevention, and management of these tumors in the elderly.

El melanoma cutáneo (MC) es el tumor cutáneo que más muertes provoca, con un aumento importante de la incidencia y la mortalidad en las últimas décadas, especialmente en el paciente anciano. Existen evidencias del diferente comportamiento biológico, así como de las diferencias en el manejo del MC en este subgrupo de pacientes con respecto al resto de otras franjas de edad, evidentemente condicionadas por unas limitadas expectativas de supervivencia y calidad de vida ajenas al melanoma y una elevada incidencia de comorbilidades. El presente artículo revisa los datos actuales más relevantes de la epidemiología, etiopatogenia e inmunología, clínica, prevención y manejo del MC en el anciano.

Mitotic rate is no longer considered a staging criterion for thin melanoma in the 8th edition of the American Joint Committee on Cancer Staging Manual. The aim of this observational study was to identify prognostic factors for thin melanoma and predictors and prognostic significance of sentinel lymph node (SLN) involvement in a large multicenter cohort of patients with melanoma from nine tertiary care hospitals. A total of 4249 consecutive patients with thin melanoma diagnosed from January 1, 1998 to December 31, 2016 were included. The main outcomes were disease-free interval and melanoma-specific survival for the overall population and predictors of SLN metastasis (n = 1083). Associations between survival and SLN status and different clinical and pathologic variables (sex, age, tumor location, mitosis, ulceration, regression, lymphovascular invasion, histologic subtype, Clark level, and Breslow thickness) were analyzed by Cox proportional hazards regression and logistic regression. SLN status was the most important prognostic factor for melanoma-specific survival (hazard ratio, 13.8; 95% CI, 6.1-31.2; P < 0.001), followed by sex, ulceration, and Clark level for patients who underwent SLNB. A mitotic rate of >2 mitoses/mm(2) was the only factor associated with a positive SLN biopsy (odds ratio, 2.9; 95% CI, 1.22-7; P = 0.01. SLN status is the most important prognostic factor in thin melanoma. A high mitotic rate is associated with metastatic SLN involvement. SLN biopsy should be discussed and recommended in patients with thin melanoma and a high mitotic rate.