RESUMO
At present times, general surgeons are continuously faced to evaluate patients with pigmented lesions. Thus, is very important that surgeons acquire adequate knowledge not only to distinguish between suspicious lesion and non suspicious lesion, but also to correctly assess when and how to perform a skin biopsy. The early detection of melanoma and non melanoma skin cancer is one of the most important factors to achieve a better prognosis. The main objective of this article is to provide surgeons some tips and pitfalls to help accurate the evaluation and diagnosis of pigmented lesions. The authors also want to stress out the importance of the team work between surgeons and dermatologist, due that is well documented that multidisciplinary approach to skin cancer raises the possibilities of early diagnosis, adequate treatment and better results for patients with skin cancer.
En la actualidad, el cirujano continuamente se ve enfrentado a evaluar distintos tipos de lesiones cutáneas en los pacientes, por lo que debe tener conocimientos de las características que hacen que una lesión sea sospechosa o no, para evaluar correctamente cuándo y cómo realizar una biopsia de una lesión cutánea. El diagnóstico precoz, tanto del melanoma como del cáncer de piel no melanoma, ha demostrado ser clave para mejorar el pronóstico de nuestros pacientes. Este artículo pretende entregar algunas claves para afinar la evaluación y diagnóstico de las lesiones pigmentadas. Es muy importante también, recalcar la importancia del trabajo conjunto de los cirujanos con los dermatólogos, ya que la evaluación y manejo multidisciplinario mejora sustancialmente el diagnóstico, tratamiento y resultados de los pacientes con cáncer de piel.
Assuntos
Humanos , Biópsia/normas , Neoplasias Cutâneas/patologia , Seleção de Pacientes , Biópsia/efeitos adversos , Dermatopatias/patologia , Fatores de RiscoRESUMO
El melanoma maligno cutáneo (MMC) es un cáncer genéticamente heterogéneo, en cuya patogénesis participarían varios genes. Algunos de estos activan la vía MAP kinasa (BRAF, NRAS, KIT, NF1), mientras que otros confieren una mayor susceptibilidad a melanoma familiar, como CDKN2A, CDK4, MITF y BAP1. BAP1 (BRCA1-associated-protein 1) ha sido descrito como una proteína que se une a BRCA1 para inhibir el crecimiento celular. Actualmente se sabe que es producto de un gen supresor de tumores (denominado BAP1) y que actúa como una enzima con actividad deubiquitinasa, la cual se asocia a varios complejos de proteínas, regulando diversas vías celulares relacionadas con el ciclo celular, diferenciación y muerte celular, así como también gluconeogénesis y respuesta a daño del ADN. Tanto su actividad deubiquitinasa como su localización nuclear son relevantes para su función en la supresión de tumores.
Malignant cutaneous melanoma (MMC) is a genetically heterogeneous cancer and various genes participate in its pathogenesis. Some of these genes activate the MAP kinase pathway (BRAF, NRAS, KIT, NF1) and others are related to a higher susceptibility to familial melanoma like CDKN2A, CDK4, MITF y BAP1. BAP1 (BRCA1-associated protein 1) has been described as a BRCA1-binding protein inhibiting cell growth. This protein is a product of a gene with tumor suppressor activity, the protein being a deubiquitinase associated to multiple protein complexes regulating various cellular pathways, including the cell cycle, differentiation and cell death, as well as gluconeogenesis and DNA damage response. Both deubiquitinase activity and location to the nucleus are relevant to its tumor suppressor function.
Assuntos
Humanos , Neoplasias Cutâneas/genética , Melanoma/genética , Proteínas Supressoras de Tumor/genética , Ubiquitina Tiolesterase/genética , Proteínas Supressoras de Tumor/metabolismo , Ubiquitina Tiolesterase/metabolismo , MutaçãoRESUMO
Antecedentes: El carcinoma espinocelular (CEC) es una neoplasia epitelial maligna. La mayor parte se concentra en 4 áreas: cáncer de piel no melanoma, de cabeza y cuello, esofágico y pulmonar. El riesgo de metástasis de CEC es de 0,3-3,7 por ciento. El CEC vulvar representa aproximadamente un 3-5 por ciento de los cánceres ginecológicos. Caso clínico: Mujer de 86 años con prurito genital de larga data. Evaluada en varias oportunidades, siendo tratada como Herpes genital con valaciclovir, y Liquen Escleroso y Atrófico (LEA) con corticoides tópicos y tacrolimus con mala respuesta. Consultó por intenso prurito y nuevas lesiones vulvares. Al examen físico, destacaban 2 nódulos ulcerados en región periclitorídea izquierda e introito. La biopsia confirmó CEC bien diferenciado infiltrante. El TAC de abdomen y pelvis descartó metástasis. Se realizó radioterapia por 7 semanas. Por persistencia de la lesión, ingresó a cuidados paliativos. Dos años después la paciente está en buenas condiciones. Discusión: El CEC representa el 95 por ciento de las neoplasias vulvares. Existen 2 tipos: CEC en mujeres jóvenes, asociado a infección por virus papiloma humano de alto riesgo y CEC en mujeres mayores en relación a LEA. El 45-61 por ciento de los CEC de vulva se asocian a LEA preexistente, por lo que se recomienda el seguimiento de pacientes portadoras de LEA cada 6 meses. Conclusión: Es importante realizar biopsias de lesiones vulvares con mala respuesta a tratamiento, sobre todo si se asocia a LEA.
Background: Squamous cell carcinoma (SCC) is a malignant epithelial neoplasm. SCC can be divided into 4 groups: non-melanoma skin cancer (NMSC), head and neck, esophageal and lung cancer. The risk for metastasis of SCC is 0.3-3.7 percent. Vulvar SCC is approximately 3-5 percent of all gynecological cancers. Case report: An 86-year old woman with a history of several years of genital pruritus and many consultations for this reason, prior treatments included valacyclovir for genital herpes; topical corticosteroids and tachrolymus for lichen sclerosus et atrophicus (LEA) with poor response. She presented with pruritus and new vulvar lesions. Physical examination showed two ulcerated nodules on the left periclitorid region and the introitus. The biopsy confirmed an infiltrating well-differentiated SCC. CT-scans discarded metastases. She received 7 weeks of radiotherapy. Due to persistence of the tumor the patient entered palliative care. Two years afterwards the patient is in good condition. Discussion: SCC represents 95 percent of vulvar malignancies. There are 2 types: SCC in young women, associated with high-risk human papilloma virus infection and SCC in elder women associated to the preexistence of LEA. 45-61 percent of vulvar SCC is associated in with preexisting LEA. Patients with LEA should be followed every 6 months. Conclusion: It is important to perform biopsies of vulvar lesions that have poor response to treatment, especially if they are associated with LEA.
Assuntos
Humanos , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/radioterapia , Neoplasias Vulvares/diagnóstico , Neoplasias Vulvares/radioterapiaRESUMO
BACKGROUND: Human T-lymphotropic virus-1 (HTLV-1) infection has been associated with the pathogenesis of cutaneous T cell lymphomas (CTCL). AIM: To search for HTLV-1 DNA in skin biopsies of patients with CTCL. MATERIAL AND METHODS: A retrospective study was conducted using 25 biopsies of patients with CTCL. DNA was extracted from lymphoid tissue by microdissection. A nested PCR was conducted to detect HTLV-1 genome using primers for the tax region. As negative controls, four cases of superficial perivascular dermatitis were chosen. As positive controls, five cases of T-cell leukemia/lymphoma (ATCL) were studied. RESULTS: A positive reaction was found in 3 of 25 cases. These biopsies corresponded to a case of Mycosis Fungoides, a case of CD30 (-) T-cell lymphoma and a case of lymphomatoid papulosis. Search was negative in the four cases of superficial perivascular dermatitis and positive in four cases of adult T-cell leukemia/lymphoma (ATCL). CONCLUSIONS: HTLV-1 DNA search in tissues is a useful tool recommended to study T-cell lymphomas. HTLV-1 infection only occurs in sporadic cases but may contribute to tumor aggressiveness and prognosis.
Assuntos
DNA Viral/análise , Infecções por HTLV-I/virologia , Vírus Linfotrópico T Tipo 1 Humano/genética , Linfoma Cutâneo de Células T/virologia , Micose Fungoide/virologia , Neoplasias Cutâneas/virologia , Adulto , Idoso , Biópsia , Estudos de Casos e Controles , Pré-Escolar , Feminino , Infecções por HTLV-I/patologia , Humanos , Imuno-Histoquímica , Linfoma Cutâneo de Células T/patologia , Masculino , Pessoa de Meia-Idade , Micose Fungoide/patologia , Reação em Cadeia da Polimerase , Estudos Retrospectivos , Neoplasias Cutâneas/patologia , Adulto JovemRESUMO
Background: Human T-lymphotropic virus-1 (HTLV-1) infection has been associated with the pathogenesis of cutaneous T cell lymphomas (CTCL). Aim: To search for HTLV-1 DNA in skin biopsies of patients with CTCL. Material and Methods: A retrospective study was conducted using 25 biopsies of patients with CTCL. DNA was extracted from lymphoid tissue by microdissection. A nested PCR was conducted to detect HTLV-1 genome using primers for the tax region. As negative controls, four cases of superficial perivascular dermatitis were chosen. As positive controls, five cases of T-cell leukemia/lymphoma (ATCL) were studied. Results: A positive reaction was found in 3 of 25 cases. These biopsies corresponded to a case of Mycosis Fungoides, a case of CD30 (-) T-cell lymphoma and a case of lymphomatoid papulosis. Search was negative in the four cases of superficial perivascular dermatitis and positive in four cases of adult T-cell leukemia/lymphoma (ATCL). Conclusions: HTLV-1 DNA search in tissues is a useful tool recommended to study T-cell lymphomas. HTLV-1 infection only occurs in sporadic cases but may contribute to tumor aggressiveness and prognosis.
Assuntos
Adulto , Idoso , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , DNA Viral/análise , Infecções por HTLV-I/virologia , Vírus Linfotrópico T Tipo 1 Humano/genética , Linfoma Cutâneo de Células T/virologia , Micose Fungoide/virologia , Neoplasias Cutâneas/virologia , Biópsia , Estudos de Casos e Controles , Infecções por HTLV-I/patologia , Imuno-Histoquímica , Linfoma Cutâneo de Células T/patologia , Micose Fungoide/patologia , Reação em Cadeia da Polimerase , Estudos Retrospectivos , Neoplasias Cutâneas/patologiaRESUMO
Skin necrosis must be considered as a syndrome, because it is a clinical manifestation of different diseases. An early diagnosis is very important to choose the appropriate treatment. Therefore, its causes should be suspected and confirmed quickly. We report eleven patients with skin necrosis seen at our Department, caused by different etiologies: Warfarin-induced skin necrosis, loxoscelism, diabetic microangiopathy, ecthyma gangrenosum, disseminated intravascular coagulation, necrotizing vasculitis, paraneoplastic extensive necrotizing vasculitis, livedoid vasculopathy, necrotizing fasciitis, necrosis secondary to the use of vasoactive drugs and necrosis secondary to the use of cocaine. We also report the results of our literature review on the subject.
Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dermatopatias/patologia , Pele/patologia , Necrose/etiologia , Dermatopatias/etiologiaRESUMO
La Micosis Fungoide (MF) es el linfoma cutáneo más común de células T. Tiene un comportamiento indolente, llevando a algunos a utilizar el término de linfoma cutáneo de células T (LLCT) como sinónimo de la MF. Se caracteriza por una erupción cutánea crónica, generalizada, y clínicamente por la evolución de los parches en placas y tumores. A continuación se presentará un caso clínico que tras un diagnóstico de liquen plano refractario a tratamiento, se diagnostica micosis fungoide folicular.
Mycosis fungoides (MF) is recognized as the most common cutaneous T-cell lymphoma (CTCL). It has an indolent behavior, leading some to use the term cutaneous T-cell lymphoma as synonymous of MF. It is characterized by chronic, widespread rash, and clinically by the evolution of patches in plaques and tumors. We describe our experience with a case that after a diagnosis of lichen planus refractory to treatment, we diagnosed follicular mycosis fungoides.