Background: Fifteen to forty percent of patients with localized cutaneous melanoma (CM) (stages I... more Background: Fifteen to forty percent of patients with localized cutaneous melanoma (CM) (stages I–II) will experience disease relapse. The 31-gene expression profile (31-GEP) uses gene expression data from the primary tumor in conjunction with clinicopathologic features to refine patient prognosis. The study’s objective was to evaluate 31-GEP risk stratification for disease-free survival (DFS) in a previously published cohort with longer follow-up. Methods: Patients with stage IB–II CM (n = 86) were prospectively tested with the 31-GEP. Follow-up time increased from 2.2 to 3.9 years. Patient outcomes were compared using Kaplan-Meier and Cox regression analysis. Results: A Class 2B result was a significant predictor of 3-year DFS (hazard ratio (HR) 8.4, p = 0.008) in univariate analysis. The 31-GEP significantly stratified patients by risk of relapse (p = 0.005). A Class 2B result was associated with a lower 3-year DFS (75.0%) than a Class 1A result (100%). The 31-GEP had a high sens...
Characterization of patients, surgery procedures and the risk factors for dermatofibrosarcoma pro... more Characterization of patients, surgery procedures and the risk factors for dermatofibrosarcoma protuberans (DFSP) recurrences is poorly defined. In this study, we aimed to describe the demographics, tumor characteristics and interventions of DFSP treated with Mohs micrographic surgery (MSS) to determine the rate and risk factors for recurrence. Data were collected from REGESMOHS, a nationwide prospective cohort study of patients treated with MMS in Spain. From July 2013 to February 2020, 163 patients with DFSP who underwent MMS were included. DFSP was mostly located on trunk and extremities. Recurrent tumors had deeper tumor invasion and required higher number of MMS stages. Paraffin MMS was the most frequently used technique. Overall recurrence rate was 0.97 cases/100 person‐years (95% IC = 0.36–2.57). No differences were found in epidemiological, tumor, surgery characteristics or surgical technique (frozen or paraffin MMS [p = 0.6641]) in terms of recurrence. Median follow‐up time ...
Skin cancer is a malign tumour, highly metastatic, that has undergone a spectacular increase in a... more Skin cancer is a malign tumour, highly metastatic, that has undergone a spectacular increase in all of its clinical forms in the last 40 years, with a threefold increase in its incidence. Besides genetic predisposition, intense exposure to sunlight by light skinned patients, together with antecedents of sunburn during childhood, constitute the principal risk factor for its appearance. Many clinical and histological observations suggest a clear interaction between the immune system of the host and skin cancer. In the disease's progression, in the passage from a phase of horizontal growth to an invasive phase of vertical growth - the determinant factor in prognosis - factors intervene that are only partially understood. Angiogenesis, or the development of new vessels, is necessary to maintain the growth, invasion and metastatic capacity of a tumour. VEGF and bFGF are outstanding amongst the pro-angiogenic cytokines secreted by the skin cancer cells; these favour endothelial prolif...
Cutaneous squamous cell carcinoma (cSCC) is the second most common cancer in humans and its incid... more Cutaneous squamous cell carcinoma (cSCC) is the second most common cancer in humans and its incidence is both underestimated and on the rise. cSCC is referred to in the literature as high-risk cSCC, locally advanced cSCC, metastatic cSCC, advanced cSCC, and aggressive cSCC. These terms can give rise to confusion and are not always well defined. In this review, we aim to clarify the concepts underlying these terms with a view to standardizing the description of this tumor, something we believe is necessary in light of the new drugs that have been approved or are in development for cSCC.
JDDG: Journal der Deutschen Dermatologischen Gesellschaft, 2020
Various techniques have been described for the reconstruction of surgical defects of the upper li... more Various techniques have been described for the reconstruction of surgical defects of the upper lip after skin cancer. Here, we propose a technique for reconstructing medium or large defects located at the junction of the nasogenian and nasolabial folds with a hatchet flap. We report on three patients treated with this technique, describing the surgical procedure and some interesting caveats. Two patients reconstructed with direct closure in this location are described in order to emphasize the better aesthetic result achieved with the hatchet flap, especially in terms of symmetry. While direct closure tends to decrease the ipsilateral nasolabial fold, the hatchet flap extends the scar to the fold below the commissure in a natural wrinkle, becoming symmetrical and much less noticeable after a few months. We conclude that the hatchet flap is technically easy and rapidly implemented for defects in the apical triangle of the upper lip, and achieves better results in terms of facial symmetry than direct closure.
JDDG: Journal der Deutschen Dermatologischen Gesellschaft, 2020
Für die Rekonstruktion chirurgischer Defekte im Hautbereich der Oberlippe nach Hautkrebs sind ver... more Für die Rekonstruktion chirurgischer Defekte im Hautbereich der Oberlippe nach Hautkrebs sind verschiedene Techniken beschrieben worden. Wir stellen die Technik des axtförmigen Lappens (hatchet flap) für die Rekonstruktion mittelgroßer oder großer Defekte im Hautbereich der Oberlippe am Übergang des Sulcus alaris und der Nasiolabialfalte vor. Wir berichten über drei Patienten, die mit dieser Technik versorgt wurden, und beschreiben den chirurgischen Eingriff und einige wichtige Vorbehalte. Um das bessere ästhetische Ergebnis, das mit einem hatchet flap erreicht werden kann, insbesondere in Bezug auf die Symmetrie zu verdeutlichen, werden darüber hinaus zwei Patientenfälle, die mit einem Direktverschluss in dieser Lokalisation rekonstruiert wurden, vorgestellt. Die Technik des Direktverschlusses führt oft zu einer verkürzten ipsilateralen Nasolabialfalte. Mit dem hatchet flap wird die Narbe zwar bis zur Hautrinne unterhalb der oralen Kommissur verlängert, ist aber symmetrisch und in einer natürlichen Falte verborgen und fällt nach einigen Monaten deutlich weniger auf. Unsere Schlussfolgerung ist, dass der hatchet flap bei Defekten im apikalen Dreieck der Oberlippe technisch einfach und schnell umzusetzen ist und hinsichtlich der Gesichtssymmetrie bessere Ergebnisse erzielt als ein Direktverschluss.
Atopic dermatitis (AD) is a chronic cutaneous inflammatory disorder, characterized by skin barrie... more Atopic dermatitis (AD) is a chronic cutaneous inflammatory disorder, characterized by skin barrier disruption. Dermacare is a new cosmetic formulation, which enhances moisturization, reinforces and repairs the skin barrier, and prevents cutaneous microbiota imbalance. To demonstrate its safety and efficacy, a prospective, open-label, and multicenter study was carried out on patients diagnosed with mild to moderate AD. Transepidermal water loss (TEWL), clinical severity, Desquamation Index, Patient/Investigator Global Assessments, quality of life index, and tolerance were assessed. Adverse events were recorded. Daily application of the new treatment was well tolerated, and adverse events were absent. After 14 days, TEWL showed a 36.7% significant decrease (p = 0.035). At the end of the 28-day treatment, the Desquamation Index showed a reduction in 70% of patients; Eczema Area and Severity Index were reduced by 70.4% (p = 0.002); and skin irritation showed a significant reduction (p =...
Forehead reconstruction after Mohs surgery has become a challenge for dermatology surgeons, and a... more Forehead reconstruction after Mohs surgery has become a challenge for dermatology surgeons, and achieving an excellent cosmetic and functional result is imperative in this location. To highlight the utility of a frontalis myocutaneous transposition flap (FMTF) for forehead reconstruction after Mohs surgery. Surgical technique case series including 12 patients with large forehead defects recruited between January 2010 and June 2017 at the Dermatology Department of the University Clinic of Navarra, Spain. All patients underwent Mohs micrographic surgery for skin cancer (5 basal cell carcinomas, 4 melanomas, 2 squamous cell carcinomas, and 1 adnexal tumor) located on the forehead (8 paramedian, 2 midline, and 2 lateral subunits) resulting in defects ranging from 9 to 28 cm2 in size. Mohs micrographic surgery followed by FMTF. Taking into account the defect's size and location, a lateral lobulated flap is designed with an inferior pedicle and incision lines are made vertically to th...
Introduction: The basic principle of a lobed or finger-like transposition flap is that, after cov... more Introduction: The basic principle of a lobed or finger-like transposition flap is that, after covering the defect with the transposed tissue, the donor site is closed primarily. With large defects, a second lobe may be added to the flap if primary closure of the area left by the first lobe is not possible. The flap can often be made to adapt to the defect, but this maneuver, in combination with primary closure of the adjacent tissue, can sometimes produce excessive tension and compromise the blood supply. Material and methods: We present a series of 4 patients with epithelial tumors of the lateral wall of the nose. The defects left by surgical excision were covered by finger-like transposition flaps. Subcutaneous sutures called guitar-string sutures were used to reduce the size of the defect and facilitate tension-free closure. Conclusions: We propose use of the guitar-string subcutaneous suture in those cases in which the defect is larger than the area that can be covered by the flap. This will make it easier to adapt the flap to the defect and will reduce the risk of excessive tension causing necrosis of the transposed tissue.
Although capillary malformations (CMs) are not usually serious health problems in themselves, the... more Although capillary malformations (CMs) are not usually serious health problems in themselves, they can occasionally be warning signs for syndromes with more serious or aggressive vascular malformations not readily apparent at birth or on initial examination. We describe a series of 9 patients with a common phenotype: (1) CM on the fingertips; (2) associated combined vascular (lymphatic-venous) malformations on the trunk and/or extremities; and (3) in some cases, partial overgrowth and asymmetry of the extremities. Data were collected retrospectively for patients with CM on the fingertips who were treated at 2 Vascular Anomalies Centers from January 2006 to January 2016. All the patients presented CM and other associated vascular abnormalities from birth. CMs were centripetal in their distribution. The greater the centripetal progression of the CM, the greater the associated vascular malformation observed. Some patients also presented varying degrees of overgrowth and asymmetry. At p...
The typical reconstructive option for closing large-sized defects of the distal half of the nose ... more The typical reconstructive option for closing large-sized defects of the distal half of the nose is the paramedian forehead flap. Other alternatives are a melolabial interpolation flap and bilobed or trilobed flaps. The dorsal nasal (Rieger) flap is suitable for closing small-sized defects at this location, especially when they are medially located. The authors describe a modified dorsal nasal flap reconstruction for large nasal defects. The novelty of this study lies in lengthening the leading edge of flap rotation, which may provide tissue either from the adjacent nasal skin, the nasofacial groove, or the cheek. The authors performed a retrospective chart review of all patients with large defects (>20 mm) of the nose who underwent modified dorsal nasal flap repair between January 2004 and March 2015 at a single academic center. Twenty-seven patients (16 male, 11 female; ages 44-88, mean age 62 years) had defects (the smallest 15 × 21 mm, and the largest 32 × 37 mm) on the lower portion of the nasal pyramid. Follow-up ranged from 12 months to 11 years with good or excellent results in all cases. Elongated dorsal nasal flap is a reproducible one-stage flap for large defects of the nose, with minimal risk of aesthetic or functional complications.
Background: Fifteen to forty percent of patients with localized cutaneous melanoma (CM) (stages I... more Background: Fifteen to forty percent of patients with localized cutaneous melanoma (CM) (stages I–II) will experience disease relapse. The 31-gene expression profile (31-GEP) uses gene expression data from the primary tumor in conjunction with clinicopathologic features to refine patient prognosis. The study’s objective was to evaluate 31-GEP risk stratification for disease-free survival (DFS) in a previously published cohort with longer follow-up. Methods: Patients with stage IB–II CM (n = 86) were prospectively tested with the 31-GEP. Follow-up time increased from 2.2 to 3.9 years. Patient outcomes were compared using Kaplan-Meier and Cox regression analysis. Results: A Class 2B result was a significant predictor of 3-year DFS (hazard ratio (HR) 8.4, p = 0.008) in univariate analysis. The 31-GEP significantly stratified patients by risk of relapse (p = 0.005). A Class 2B result was associated with a lower 3-year DFS (75.0%) than a Class 1A result (100%). The 31-GEP had a high sens...
Characterization of patients, surgery procedures and the risk factors for dermatofibrosarcoma pro... more Characterization of patients, surgery procedures and the risk factors for dermatofibrosarcoma protuberans (DFSP) recurrences is poorly defined. In this study, we aimed to describe the demographics, tumor characteristics and interventions of DFSP treated with Mohs micrographic surgery (MSS) to determine the rate and risk factors for recurrence. Data were collected from REGESMOHS, a nationwide prospective cohort study of patients treated with MMS in Spain. From July 2013 to February 2020, 163 patients with DFSP who underwent MMS were included. DFSP was mostly located on trunk and extremities. Recurrent tumors had deeper tumor invasion and required higher number of MMS stages. Paraffin MMS was the most frequently used technique. Overall recurrence rate was 0.97 cases/100 person‐years (95% IC = 0.36–2.57). No differences were found in epidemiological, tumor, surgery characteristics or surgical technique (frozen or paraffin MMS [p = 0.6641]) in terms of recurrence. Median follow‐up time ...
Skin cancer is a malign tumour, highly metastatic, that has undergone a spectacular increase in a... more Skin cancer is a malign tumour, highly metastatic, that has undergone a spectacular increase in all of its clinical forms in the last 40 years, with a threefold increase in its incidence. Besides genetic predisposition, intense exposure to sunlight by light skinned patients, together with antecedents of sunburn during childhood, constitute the principal risk factor for its appearance. Many clinical and histological observations suggest a clear interaction between the immune system of the host and skin cancer. In the disease's progression, in the passage from a phase of horizontal growth to an invasive phase of vertical growth - the determinant factor in prognosis - factors intervene that are only partially understood. Angiogenesis, or the development of new vessels, is necessary to maintain the growth, invasion and metastatic capacity of a tumour. VEGF and bFGF are outstanding amongst the pro-angiogenic cytokines secreted by the skin cancer cells; these favour endothelial prolif...
Cutaneous squamous cell carcinoma (cSCC) is the second most common cancer in humans and its incid... more Cutaneous squamous cell carcinoma (cSCC) is the second most common cancer in humans and its incidence is both underestimated and on the rise. cSCC is referred to in the literature as high-risk cSCC, locally advanced cSCC, metastatic cSCC, advanced cSCC, and aggressive cSCC. These terms can give rise to confusion and are not always well defined. In this review, we aim to clarify the concepts underlying these terms with a view to standardizing the description of this tumor, something we believe is necessary in light of the new drugs that have been approved or are in development for cSCC.
JDDG: Journal der Deutschen Dermatologischen Gesellschaft, 2020
Various techniques have been described for the reconstruction of surgical defects of the upper li... more Various techniques have been described for the reconstruction of surgical defects of the upper lip after skin cancer. Here, we propose a technique for reconstructing medium or large defects located at the junction of the nasogenian and nasolabial folds with a hatchet flap. We report on three patients treated with this technique, describing the surgical procedure and some interesting caveats. Two patients reconstructed with direct closure in this location are described in order to emphasize the better aesthetic result achieved with the hatchet flap, especially in terms of symmetry. While direct closure tends to decrease the ipsilateral nasolabial fold, the hatchet flap extends the scar to the fold below the commissure in a natural wrinkle, becoming symmetrical and much less noticeable after a few months. We conclude that the hatchet flap is technically easy and rapidly implemented for defects in the apical triangle of the upper lip, and achieves better results in terms of facial symmetry than direct closure.
JDDG: Journal der Deutschen Dermatologischen Gesellschaft, 2020
Für die Rekonstruktion chirurgischer Defekte im Hautbereich der Oberlippe nach Hautkrebs sind ver... more Für die Rekonstruktion chirurgischer Defekte im Hautbereich der Oberlippe nach Hautkrebs sind verschiedene Techniken beschrieben worden. Wir stellen die Technik des axtförmigen Lappens (hatchet flap) für die Rekonstruktion mittelgroßer oder großer Defekte im Hautbereich der Oberlippe am Übergang des Sulcus alaris und der Nasiolabialfalte vor. Wir berichten über drei Patienten, die mit dieser Technik versorgt wurden, und beschreiben den chirurgischen Eingriff und einige wichtige Vorbehalte. Um das bessere ästhetische Ergebnis, das mit einem hatchet flap erreicht werden kann, insbesondere in Bezug auf die Symmetrie zu verdeutlichen, werden darüber hinaus zwei Patientenfälle, die mit einem Direktverschluss in dieser Lokalisation rekonstruiert wurden, vorgestellt. Die Technik des Direktverschlusses führt oft zu einer verkürzten ipsilateralen Nasolabialfalte. Mit dem hatchet flap wird die Narbe zwar bis zur Hautrinne unterhalb der oralen Kommissur verlängert, ist aber symmetrisch und in einer natürlichen Falte verborgen und fällt nach einigen Monaten deutlich weniger auf. Unsere Schlussfolgerung ist, dass der hatchet flap bei Defekten im apikalen Dreieck der Oberlippe technisch einfach und schnell umzusetzen ist und hinsichtlich der Gesichtssymmetrie bessere Ergebnisse erzielt als ein Direktverschluss.
Atopic dermatitis (AD) is a chronic cutaneous inflammatory disorder, characterized by skin barrie... more Atopic dermatitis (AD) is a chronic cutaneous inflammatory disorder, characterized by skin barrier disruption. Dermacare is a new cosmetic formulation, which enhances moisturization, reinforces and repairs the skin barrier, and prevents cutaneous microbiota imbalance. To demonstrate its safety and efficacy, a prospective, open-label, and multicenter study was carried out on patients diagnosed with mild to moderate AD. Transepidermal water loss (TEWL), clinical severity, Desquamation Index, Patient/Investigator Global Assessments, quality of life index, and tolerance were assessed. Adverse events were recorded. Daily application of the new treatment was well tolerated, and adverse events were absent. After 14 days, TEWL showed a 36.7% significant decrease (p = 0.035). At the end of the 28-day treatment, the Desquamation Index showed a reduction in 70% of patients; Eczema Area and Severity Index were reduced by 70.4% (p = 0.002); and skin irritation showed a significant reduction (p =...
Forehead reconstruction after Mohs surgery has become a challenge for dermatology surgeons, and a... more Forehead reconstruction after Mohs surgery has become a challenge for dermatology surgeons, and achieving an excellent cosmetic and functional result is imperative in this location. To highlight the utility of a frontalis myocutaneous transposition flap (FMTF) for forehead reconstruction after Mohs surgery. Surgical technique case series including 12 patients with large forehead defects recruited between January 2010 and June 2017 at the Dermatology Department of the University Clinic of Navarra, Spain. All patients underwent Mohs micrographic surgery for skin cancer (5 basal cell carcinomas, 4 melanomas, 2 squamous cell carcinomas, and 1 adnexal tumor) located on the forehead (8 paramedian, 2 midline, and 2 lateral subunits) resulting in defects ranging from 9 to 28 cm2 in size. Mohs micrographic surgery followed by FMTF. Taking into account the defect's size and location, a lateral lobulated flap is designed with an inferior pedicle and incision lines are made vertically to th...
Introduction: The basic principle of a lobed or finger-like transposition flap is that, after cov... more Introduction: The basic principle of a lobed or finger-like transposition flap is that, after covering the defect with the transposed tissue, the donor site is closed primarily. With large defects, a second lobe may be added to the flap if primary closure of the area left by the first lobe is not possible. The flap can often be made to adapt to the defect, but this maneuver, in combination with primary closure of the adjacent tissue, can sometimes produce excessive tension and compromise the blood supply. Material and methods: We present a series of 4 patients with epithelial tumors of the lateral wall of the nose. The defects left by surgical excision were covered by finger-like transposition flaps. Subcutaneous sutures called guitar-string sutures were used to reduce the size of the defect and facilitate tension-free closure. Conclusions: We propose use of the guitar-string subcutaneous suture in those cases in which the defect is larger than the area that can be covered by the flap. This will make it easier to adapt the flap to the defect and will reduce the risk of excessive tension causing necrosis of the transposed tissue.
Although capillary malformations (CMs) are not usually serious health problems in themselves, the... more Although capillary malformations (CMs) are not usually serious health problems in themselves, they can occasionally be warning signs for syndromes with more serious or aggressive vascular malformations not readily apparent at birth or on initial examination. We describe a series of 9 patients with a common phenotype: (1) CM on the fingertips; (2) associated combined vascular (lymphatic-venous) malformations on the trunk and/or extremities; and (3) in some cases, partial overgrowth and asymmetry of the extremities. Data were collected retrospectively for patients with CM on the fingertips who were treated at 2 Vascular Anomalies Centers from January 2006 to January 2016. All the patients presented CM and other associated vascular abnormalities from birth. CMs were centripetal in their distribution. The greater the centripetal progression of the CM, the greater the associated vascular malformation observed. Some patients also presented varying degrees of overgrowth and asymmetry. At p...
The typical reconstructive option for closing large-sized defects of the distal half of the nose ... more The typical reconstructive option for closing large-sized defects of the distal half of the nose is the paramedian forehead flap. Other alternatives are a melolabial interpolation flap and bilobed or trilobed flaps. The dorsal nasal (Rieger) flap is suitable for closing small-sized defects at this location, especially when they are medially located. The authors describe a modified dorsal nasal flap reconstruction for large nasal defects. The novelty of this study lies in lengthening the leading edge of flap rotation, which may provide tissue either from the adjacent nasal skin, the nasofacial groove, or the cheek. The authors performed a retrospective chart review of all patients with large defects (>20 mm) of the nose who underwent modified dorsal nasal flap repair between January 2004 and March 2015 at a single academic center. Twenty-seven patients (16 male, 11 female; ages 44-88, mean age 62 years) had defects (the smallest 15 × 21 mm, and the largest 32 × 37 mm) on the lower portion of the nasal pyramid. Follow-up ranged from 12 months to 11 years with good or excellent results in all cases. Elongated dorsal nasal flap is a reproducible one-stage flap for large defects of the nose, with minimal risk of aesthetic or functional complications.
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Papers by Pedro Redondo