The expression pattern of interferon-inducible proteins reflects the characteristic histological distribution of infiltrating immune cells in different cutaneous lupus erythematosus subsets.
Dear Editors,We read with interest the article by Herzum et al. regarding adequate surgical margins for basal cell carcinoma (BCC) excision on the head and neck with the aid of dermoscopy. 1 We agree that current guidelines-proposed margins for BCC of the head and neck of 5-10 mm are sometimes not feasible due to complex anatomical and functional structures (e. g. eyelids, nose). Mohs micrographic surgery (MMS) or any technique with complete circumferential peripheral and deep margin assessment (CCPDMA) address this aforementioned issue; however, these techniques may not be available in all countries, and require additional resources and workload. 2 For these reasons, Herzum et al. performed a retrospective study evaluating the success rate of narrow surgical margins (1-3 mm) for BCC excision of the head and neck aided with dermoscopy. "Cases" were those with margins defined using dermoscopy and "controls" were those using clinical evaluation alone. The authors included biopsyproven low-risk histopathological subtypes (i. e., superficial and nodular) on the head and neck. No exclusion regarding facial H-zone (i. e., "mask zone" periocular, perioral, ears, cheeks) versus M-zone (forehead, cheeks, scalp) was performed. Histopathological samples were processed with the standard "bread-loafing" technique and not with MMS or CCPDMA techniques.The authors reported that in none of the "cases" (0/66), lateral margins were involved when using 3 mm margins vs 15% (10/66) of the "controls." Even when using narrower margins (1-2 mm), only 7% of cases had involved margins versus 25% of controls. No differences were seen between nodular versus superficial cases. At the one-year follow-up, only one recurrence (0.7%) was observed. Based on these findings, the authors propose that a "narrower" 3-mm excision with dermoscopy-aided margin delineation might be appropriate for small, well-defined, low-risk BCCs of the head and neck.The Herzum et al. study raises some concerning points that should be highlighted in order to interpret the results and before implementing their proposed narrow-margin model. First, margin assessment was evaluated using the "bread-loafing technique" and not MMS/CCPDMA. As they mentioned, <1% of samples are examined with standard
ResumenEl eritema flagelado es una erupción cutánea poco frecuente con múltiples causas, dentro de las cuales se encuentra la ingesta de hongos shiitake crudos o semicrudos. Se postula que es secundario a una reacción de hipersensibilidad Th-1 producida por el lentinan, un polisacárido termolábil de la pared celular del hongo. En años recientes ha aumentado su incidencia en el mundo occidental debido a la creciente popularidad de la comida asiática, en la que los hongos shiitake son un ingrediente muy utilizado. El cuadro clínico se caracteriza por la aparición de lesiones eritematosas lineales pruriginosas principalmente en tronco y extremidades, de curso autolimitado. El diagnóstico es principalmente clínico, basado en el antecedente de ingesta reciente de hongos shiitake y el rash característico y el tratamiento es sintomático con antihistamínicos y corticoides tópicos u orales. A continuación, presentamos un caso de eritema flagelado en una mujer joven secundario a ingesta de hongos shiitake, que resolvió completamente en 2 semanas.
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