Ganglio centinela en cáncer de piel no melanoma

A Rare Case of Combined Merkel Cell Cancer and Squamous Cell Carcinoma of the Face in an Older Woman of Southern Italy

Merkel cell carcinoma (MCC) is a rare, aggressive neuroendocrine skin tumor, whereas squamous cell carcinoma (SCC) is a more common form of skin cancer. Both tumors share similar risk factors, including advanced age, sun exposure, and fair skin. Cases of synchronous MCC and SCC are rare, and there are no established guidelines for their combined management. We report the case of an 85-year-old White woman from Southern Italy, presenting with a nodular lesion on her right forehead and a flat keratotic lesion on her right zygomatic region. The patient was treated with surgical excision and close postoperative follow-up. Histopathological analysis confirmed 2 distinct tumor populations in the forehead lesion: poorly differentiated neuroendocrine cells, consistent with MCC, and squamous cells with invasive characteristics. The zygomatic lesion contained only squamous cells. Despite surgical intervention and multidisciplinary postoperative care, the patient experienced recurrence within 4 months and died. This case illustrates a rare occurrence of combined MCC and SCC, presenting challenges in diagnosis and treatment. Given the lack of guidelines for managing dual diagnoses, this case highlights the need for further studies to establish standardized treatment protocols. The aggressive nature of these tumors underscores the importance of early detection and ongoing research to improve outcomes.

Eccrine Porocarcinoma: Avoiding Diagnostic Delay

Skin cancer is the most common cancer within the United States. Reports estimate that 1 in 5 Americans will develop some form of skin cancer. Eccrine porocarcinoma is a rare type of skin cancer of sweat gland origin. Eccrine porocarcinoma is most commonly found on the lower extremities. Clinically it may appear similar to benign skin lesions and it has significant metastatic potential. The authors present a case report with 22 months' follow-up. It describes a multiyear delay in diagnosis involving 3 specialties, including primary care, dermatology, and wound physical therapy. Information is given on techniques when high-risk cutaneous cancers are suspected or encountered. A multispecialty treatment plan is discussed.Levels of Evidence: Level V.

Sentinel node necrosis is a negative prognostic factor in patients with nasopharyngeal carcinoma: a magnetic resonance imaging study of 252 patients

PURPOSE

We explored the patterns of sentinel node metastasis and investigated the prognostic value of sentinel node necrosis (snn) in patients with nasopharyngeal carcinoma (npc), based on magnetic resonance imaging (mri).

METHODS

This retrospective study enrolled 252 patients at our institution who had metastatic lymph nodes from biopsy-confirmed npc and who were treated with definitive radiation therapy, with or without chemotherapy. All participants underwent mri before treatment, and the resulting images were reviewed to evaluate lymph node status. The patients were divided into snn and non-snn groups. Overall survival (os), tumour-free survival (tfs), regional relapse-free survival (rrfs), and distant metastasis-free survival (dmfs) were calculated by the Kaplan-Meier method, and differences were compared using the log-rank test. Factors predictive of outcome were determined by univariate and multivariate analysis.

RESULTS

Of the 252 patients, 189 (75%) had retropharyngeal lymph node metastasis, and 189 (75%) had level iia or iib lymph node necrosis. The incidence of snn was 43.4% (91 of 210 patients with lymph node metastasis or necrosis, or both). After a median follow-up of 54 months, the 5-year rates of os, tfs, rrfs, and dmfs in the snn and non-snn groups were, respectively, 79.4% and 95.3%, 73.5% and 93.3%, 80.4% and 96.6%, and 75.5% and 95.3% (all p < 0.01). Age greater than 40 years, snn, T stage, and N stage were significant independent negative prognostic factors for os, tfs, rrfs, and dmfs.

CONCLUSIONS

Metastatic retropharyngeal lymph nodes and necrotic level ii nodes both seem to act as sentinels. Sentinel node necrosis is an negative prognostic factor in patients with npc. Patients with snn have a worse prognosis.