Teresa Ródenas‐Herranz

Background: Cutaneous malignant melanoma (CMM) represents a global public health problem. Epidemiological studies about CMM trends tend to focus on single indicators or lack information about tumour characteristics that can help gain a more thorough understanding of CMM epidemiology. Objectives: To fill this gap, we studied CMM trends in incidence, mortality and survival over three decades and that considered sex, age and tumour characteristics. Methods: Data were obtained for all patients with a new diagnosis of CMM during 1985–2017 from the population-based cancer registry in Granada (Southern Spain) and for deaths owing to CMM from the Ministry of Health of the Spanish government. Incidence, mortality and survival estimates were obtained according to sex, age group, anatomical site, histological type, Breslow index and Clark level. Observed and net survival were calculated for 1, 3 and 5 years using the Kaplan–Meier and Pohar–Perme methods, respectively. Log-linear jointpoint regression was used to assess temporal trends in age-standardized rates of incidence and mortality. Results: Between 1985 and 2017, 2446 patients aged ≥ 15 years were newly diagnosed with CMM. There was a significant increase in incidence, both in males and females (annual percentage of change 4.4% and 3.7%, respectively), mainly in superficial spreading and nodular melanomas, and more pronounced among those with < 1 mm Breslow index. Mortality rates increased, mainly driven by increases among males and individuals ≥ 65 years old. Nodular melanoma had the worst prognosis, with a 5-year net survival of 62.7% in the period 2008–2017 compared with survival > 90% for other subtypes. Overall 5-year net survival improved from 78.3% in 1985–1997 to 88.6% in 2008–2017, with a clear trend by Breslow index. Conclusions: The incidence of melanoma in early stages in Southern Spain has increased over recent decades. This has been accompanied by noticeable improvements in mortality and survival, especially among younger age groups, suggesting the potential effectiveness of prevention strategies and new treatment regimens.

Dear Editor: Alopecia areata (AA) is a form of alopecia whose prevalence ranges from 0

Background Photodynamic therapy (PDT) has become one of the most effective therapies for the treatment of actinic keratosis, allowing the removal of more than one lesion in a single session. However, the pain sustained by the patient during treatment and local skin reactions can limit its use. Objectives To determine the efficacy and safety of combined PDT (daylight PDT followed by conventional PDT) vs. conventional PDT 12 weeks after treatment. Methods The study was performed as a randomized, single-center, non-inferiority clinical trial with two parallel groups. A total of 51 patients with grade I and II AKs on the scalp or face were randomized. 25 patients received one session of combined PDT (combPDT) and 26 patients received one session of conventional PDT (cPDT). The primary endpoint was the reduction of AKs, 12 weeks after treatment. The secondary endpoint was the reduction in pain and local skin reaction. Results The reduction rate of grade I and II AKs was similar in combPDT and cPDT, showing no statistically significant differences between both groups, 76.67% vs. 86.63% [p = 0.094] and 80.48% vs. 83.08% [p = 0.679], respectively. However, pain was significantly lower in the combPDT group (2.56 vs. 5, p < 0.01), as were local skin reactions. Conclusions CombPDT has proven to be as effective as cPDT for the treatment of grade I and II AKs located on the scalp and face. Furthermore, combPDT has been shown to be considerably more tolerable than cPDT, causing only mild local skin reactions.

Mycobacterium caprae, a member of theMycobacterium tuberculosiscomplex, causes tuberculosis in humans and animals, but the incidence in humans is very low worldwide. Direct contact with animals and with unpasteurized dairy products is the most frequent source of contagion. Cutaneous tuberculosis supposes a diagnostic challenge due to its variety of clinical manifestations and the difficulty in demonstrating resistant acid-alcohol bacilli in histological samples. In cases of high suspicion, the initiation of antituberculosis treatment should be considered empirically. Combined therapeutic regimens are necessary to prevent long-term resistance and complications, although the duration of treatment has not been fully established.