Faculty Bibliography

BACKGROUND: While significant risk factors for malignant melanoma may initially develop or are first seen in childhood, the actual occurrence of this neoplasm in prepubertal children is uncommon. METHODS: A retrospective study of malignant melanoma in Puerto Ricans up to 16 years of age occurring from 1973 to 1990 was carried out by identifying those cases in the Puerto Rico Cancer Registry. RESULTS: A total of seven cases were found consisting of three boys and four girls with ages ranging from 22 months to 16 years and comprising 0.94% of the total melanomas. In three of the seven cases, there was a history of a previously existent small congenital melanocytic nevus on the area. Three cases were Clark's level I, two level II, and in two cases with proved metastatic disease, Clark's level of invasion were not reported. Those cases with Clark's level I and II had a 100% 5-year survival. CONCLUSIONS: Although rare, malignant melanoma in children can be as aggressive as in adults. Among the known factors predisposing to malignant melanoma, three out of seven cases developed within a small congenital nevus, two of which occurred during the first decade of life. Due to the rarity of this event in our population, it appears unreasonable to excise all small congenital nevi during the first decade of life. Even for those who advocate excision of all small congenital nevi, the evidence at present suggests that such small nevi very rarely undergo malignant change before puberty and therefore a policy of observation in childhood and offering excision around the time of puberty is perfectly logical.

The purpose of this study was to evaluate the prevalence of dermatologic problems among patients with chronic renal failure (CRF) undergoing hemodialysis or peritoneal dialysis. One-hundred and two patients with CRF were examined for the presence of cutaneous alterations. All patients examined had at least one cutaneous lesion. The most prevalent findings were alterations in the cutaneous pigmentation. Of particular interest was an increased prevalence of hyperpigmented macules on the palms and soles. Other manifestations, seen particularly in the hemodialysis group, included the half-and-half nail, pruritus, and keratotic pits of the palms and soles. Infectious processes were more prevalent in the group undergoing peritoneal dialysis. This study showed that all patients with CRF have some type of cutaneous alteration and that the type of dialysis could have some influence upon the incidence of these changes.

Except for urticarial vasculitis, histopathological studies on the different types of urticaria are scant in the medical literature. With the purpose of evaluating the histopathological changes that occur in chronic urticarial eruptions, and to correlate the histopathological findings with the clinical presentation of the patients, skin biopsy studies were done in 36 patients with chronic urticaria. Three well-defined histopathological patterns were found: namely neutrophilic, lymphocytic, and mixed type. No cases of vasculitis were found. No specific association to the clinical presentation of the patient was found.

BACKGROUND: Controversy still exists as to whether dermatophytic skin infection is truly more common in patients with diabetes. OBJECTIVE: The purpose of this study was to determine the true prevalence of dermatophytosis in diabetic patients as compared with a control population. METHODS: One hundred consecutive diabetic patients were examined for evidence of fungal disease of the skin and compared with nondiabetic, nonimmunocompromised patients. Potassium hydroxide preparation and fungal cultures were obtained from all suspect lesions. RESULTS: Thirty-one percent of the diabetic population had culture-proven fungal infections compared with 33% of the control group. The organism most commonly isolated was Trichophyton rubrum in both groups, and the feet were the most common site of infection. Candida albicans was more prevalent in the control group, affecting the nails in particular (24% vs 15% in the diabetic patients). CONCLUSION: This study shows that there does not seem to be an increased prevalence of dermatophytosis in diabetic patients as compared with a control, nondiabetic patient.

Cutaneous lesions can be a significant problem in kidney transplant recipients. Factors such as climate and skin types have been implicated as modifiers of these clinical manifestations. With the purpose of determining the prevalence and clinical spectrum of skin diseases in a group of Hispanic kidney transplant recipients in a tropical climate, 82 serial unselected patients were examined. Seventy-eight were found to have some type of skin disease. Infections of the skin were the most common, followed by drug-induced changes and malignant or premalignant cutaneous tumors. Except for the preponderance of superficial mycotic infections, the overall results in our population are in agreement with other series.

Persons who sunbathe or engage in other activities at the beach are exposed to large amounts of UV radiation. Four hundred seven adults who visited the beaches of Puerto Rico were surveyed to determine their knowledge about the risks of sun exposure and to evaluate sunscreen use. The group consisted of 195 year-round Puerto Rican residents and 212 tourists. Ninety-five percent believed that the sun can cause skin cancer, although only half of the subset who lived all year in Puerto Rico believed that they personally received enough exposure to be at risk. The majority of the group (83%) understood the meaning of the sun protection factor numbers, although 35% used either nothing or a nonscreening oil. Half of Puerto Rican residents rarely or never used sunscreen protection while sunbathing. When sunscreen was used, the most important factor sought was given as sun protection factor (64%), followed by a perceived ability to aid in tanning (26%).

Morphea and lichen sclerosus et atrophicus are cutaneous diseases that are manifest by an early edematous stage, followed later by sclerosis and atrophy. They share features with acrodermatitis chronica atrophicans and erythema chronicum migrans, diseases that have been linked to infection by the spirochete Borrelia burgdorferi. A modified silver stain was used to identify the presence of spirochetes in skin biopsy specimens of patients with morphea and lichen sclerosus et atrophicus. Spirochetal forms were identified in the lesional skin of 10 of 25 patients with morphea and in 10 of 21 cases of lichen sclerosus et atrophicus. These spiral forms of bacteria had a significant tendency to occur in early and fully developed lesions of morphea and in early lesions of lichen sclerosus et atrophicus, whereas they tended to be absent in lesions demonstrating late pathological changes.

Tender erythematous nodules and plaques developed on the abdomen and legs of two women, 45 and 48 years of age, with hyperparathyroidism as a result of chronic renal failure caused by polycystic kidney disease. The histopathologic findings of these lesions were characterized by a calcifying panniculitis. Laboratory tests disclosed normal calcium levels and hyperphosphatemia with an elevated level of calcium phosphate product. Calciphylaxis appeared to be the mechanism of soft tissue calcification in these patients.