Ana Taibo

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 CO ₂ 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 CO ₂ 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.

Facial skin cancer and the resulting surgical scars can significantly impact patient’s quality of life. Reconstructive surgery following excision is often necessary to restore facial esthetics, with local flaps commonly used due to their favorable texture, color, and vascularity. Flaps from the same esthetic unit help minimize scarring; however, larger defects or those involving multiple anatomical units may require alternative approaches. This study evaluates the use of combined local flaps for reconstructing large facial defects or those involving multiple anatomical units after Mohs micrographic surgery, focusing on minimizing scarring and preserving facial contours. Four cases of basal cell carcinoma, each involving large defects ormultiple anatomical units, were reconstructed using combined local flaps. All cases showed successful esthetic outcomes, with well-preserved facial features and minimal scarring. In selected cases, reconstructing defects after skin cancer excision with multiple local flaps or advancements across subunits can lead to inconspicuous scars and satisfactory esthetic outcomes.

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.

Background: Subcutaneous mycoses caused by opportunistic filamentous fungi are emerging infections in developed countries due to the longer survival of immunocompromised patients. The evidence published in relation to subcutaneous mycoses is fundamentally based on case reports and small case series.Methods: We performed an observational retrospective study of subcutaneous mycoses caused by opportunistic filamentous fungi diagnosed at our institution between 2017 and 2022. This study aims to estimate the incidence rate of subcutaneous mycoses, identify which fungal species are involved, and analyse which clinical variables predispose to infection and if any are associated with mortality.Results: Fifteen patients met the inclusion criteria. The median age was 61 years (range 27–84), and 80% of them were males. Alternaria spp. were the most common fungi. Two other organisms were frequently isolated: Scedosporium apiospermum and Fusarium solani. Among patients infected with F. solani, 66.7% died. The most common clinical presentation was suppurative nodules in the lower limbs and the main risk factors for infection were immunosuppressants, corticosteroids, previous trauma and transplantation, but they were not particularly associated with increased mortality. A statistically significant association with mortality was only found in the case of positive blood culture (p = <.001).Conclusions: Phaeohyphomycosis has a lower risk of dissemination, especially when compared to subcutaneous mycoses caused by hyalohyphomycetes. It is important to convey the severity of these skin infections to the physicians involved in the treatment and follow‐up of susceptible patients to avoid misdiagnosis and delays in the treatment, especially in the case of hyalohyphomycosis.

Background: Multinucleate cell angiohistiocytoma (MCAH) is an unusual fibrohistiocytic proliferation in the dermis with vascular hyperplasia. Numerous clinicopathological studies of MCAH have been published, but little has been written in relation to treatment. Objectives: The aim of the present study is to review the therapeutical approaches for MCAH in the literature and to report the results of the different therapies followed at our institution. Methods: A literature review was conducted including all MCAH published cases that followed any therapy. Search terms included “multinucleate cell angiohistiocytoma” or “MCAH” and “treatment” or “therapy”. Also, all cases of MCAH treated at our institution from 2010 to 2020 are reported. Results: The literature search revealed 16 cases of MCAH treated with any of the therapeutic options. At our institution, 9 patients have been treated of MCAH between 2010 and 2020. Over 75% of them were female, and the median age was 56 years (range 47-73). More than 50% had lesions on the dorsum of the hands. Surgical excision was indicated in 2 patients, ablative CO2 laser was used in 1 patient and the 6 remaining ones followed vascular-targeted therapies (PDL and IPL). A satisfactory cosmetic result was achieved in all of them. Conclusions: We propose PDL therapy as a first-line treatment for MCAH since it achieves satisfactory esthetic results, while being well-tolerated. Selecting those amenable patients according to morphologic characteristics may be useful to avoid unsuccessful therapies. In MCAH with predominant fibrous stroma, surgery or CO2 laser may be the best option.