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Ramírez-Cornejo C, Muñoz-López C, Del Barrio-Díaz P, Jaque A, Majerson D, Navarrete-Dechent C, Uribe P, Vera-Kellet C. Rápida implementación de teledermatología durante la pandemia por COVID-19: lecciones aprendidas de un departamento académico de Dermatología. Rev Med Chil 2021; 149:1467-1472. [DOI: 10.4067/s0034-98872021001001467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 11/17/2021] [Indexed: 11/17/2022]
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2
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Del Puerto C, Jaque A, Gonzalez-Bombardiere S, Molgó M. Cutaneous Metastasis From Parotid Tumors: A Report of 2 Cases and Literature Review. Am J Dermatopathol 2021; 43:514-520. [PMID: 33534212 DOI: 10.1097/dad.0000000000001893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Cutaneous metastases from parotid tumors are uncommon and imply a poor prognosis. In this article, we report 2 new cutaneous metastasis cases from 2 different parotid malignancies and 42 additional cases from a literature review. Clinical manifestations, localization, and outcomes of skin metastasis from parotid tumors are described. Although infrequent, parotid neoplasms may develop skin metastasis many years after the initial diagnosis, mostly in the head and neck region. Therefore, long-term follow-up and periodic skin examination of these patients is mandatory. Dermatologists and surgeons must have a high index of suspicion when evaluating any skin lesion arising on these patients because cutaneous metastasis from parotid neoplasms generally implies a poor prognosis.
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Affiliation(s)
- Constanza Del Puerto
- Department of Dermatology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile; and
| | - Alejandra Jaque
- Department of Dermatology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile; and
| | | | - Montserrat Molgó
- Department of Dermatology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile; and
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3
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Muñoz-López C, Ramírez-Cornejo C, Marchetti MA, Han SS, Del Barrio-Díaz P, Jaque A, Uribe P, Majerson D, Curi M, Del Puerto C, Reyes-Baraona F, Meza-Romero R, Parra-Cares J, Araneda-Ortega P, Guzmán M, Millán-Apablaza R, Nuñez-Mora M, Liopyris K, Vera-Kellet C, Navarrete-Dechent C. Performance of a deep neural network in teledermatology: a single-centre prospective diagnostic study. J Eur Acad Dermatol Venereol 2020; 35:546-553. [PMID: 33037709 DOI: 10.1111/jdv.16979] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 09/22/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND The use of artificial intelligence (AI) algorithms for the diagnosis of skin diseases has shown promise in experimental settings but has not been yet tested in real-life conditions. OBJECTIVE To assess the diagnostic performance and potential clinical utility of a 174-multiclass AI algorithm in a real-life telemedicine setting. METHODS Prospective, diagnostic accuracy study including consecutive patients who submitted images for teledermatology evaluation. The treating dermatologist chose a single image to upload to a web application during teleconsultation. A follow-up reader study including nine healthcare providers (3 dermatologists, 3 dermatology residents and 3 general practitioners) was performed. RESULTS A total of 340 cases from 281 patients met study inclusion criteria. The mean (SD) age of patients was 33.7 (17.5) years; 63% (n = 177) were female. Exposure to the AI algorithm results was considered useful in 11.8% of visits (n = 40) and the teledermatologist correctly modified the real-time diagnosis in 0.6% (n = 2) of cases. The overall top-1 accuracy of the algorithm (41.2%) was lower than that of the dermatologists (60.1%), residents (57.8%) and general practitioners (49.3%) (all comparisons P < 0.05, in the reader study). When the analysis was limited to the diagnoses on which the algorithm had been explicitly trained, the balanced top-1 accuracy of the algorithm (47.6%) was comparable to the dermatologists (49.7%) and residents (47.7%) but superior to the general practitioners (39.7%; P = 0.049). Algorithm performance was associated with patient skin type and image quality. CONCLUSIONS A 174-disease class AI algorithm appears to be a promising tool in the triage and evaluation of lesions with patient-taken photographs via telemedicine.
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Affiliation(s)
- C Muñoz-López
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - C Ramírez-Cornejo
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - M A Marchetti
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - S S Han
- Dermatology Clinic, Seoul, Korea
| | - P Del Barrio-Díaz
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - A Jaque
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - P Uribe
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.,Melanoma and Skin Cancer Unit, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - D Majerson
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - M Curi
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - C Del Puerto
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - F Reyes-Baraona
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - R Meza-Romero
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - J Parra-Cares
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - P Araneda-Ortega
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - M Guzmán
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - R Millán-Apablaza
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - M Nuñez-Mora
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - K Liopyris
- Department of Dermatology, University of Athens, Andreas Syggros Hospital of Skin and Venereal Diseases, Athens, Greece
| | - C Vera-Kellet
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - C Navarrete-Dechent
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.,Melanoma and Skin Cancer Unit, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
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Jaque A, Mereniuk A, Walsh S, Shear NH, Sade S, Zagorski B, Alhusayen R. Influence of the phenotype on mycosis fungoides prognosis, a retrospective cohort study of 160 patients. Int J Dermatol 2019; 58:933-939. [DOI: 10.1111/ijd.14391] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 01/01/2019] [Accepted: 01/17/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Alejandra Jaque
- Division of Dermatology Department of Medicine Sunnybrook Health Sciences Centre Toronto Canada
| | - Alexandra Mereniuk
- Division of Dermatology Department of Medicine Sunnybrook Health Sciences Centre Toronto Canada
| | - Scott Walsh
- Division of Dermatology Department of Medicine Sunnybrook Health Sciences Centre Toronto Canada
| | - Neil H. Shear
- Division of Dermatology Department of Medicine Sunnybrook Health Sciences Centre Toronto Canada
| | - Shachar Sade
- Department of Pathology Sunnybrook Health Sciences Centre Toronto Canada
| | - Brandon Zagorski
- University of Toronto Institute for Health Policy Management and Evaluation Toronto Canada
| | - Raed Alhusayen
- Division of Dermatology Department of Medicine Sunnybrook Health Sciences Centre Toronto Canada
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Jaque A, Mereniuk A, Sade S, Lansang P, Imrie K, Shear NH. Eosinophils in the skin-a red herring masking lymphoma: a case series. SAGE Open Med Case Rep 2018; 6:2050313X18773127. [PMID: 29899986 PMCID: PMC5985601 DOI: 10.1177/2050313x18773127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Eosinophilia, both peripheral and in cutaneous tissue, is not a typical finding in mycosis fungoides; in fact, when faced with a lymphoeosinophilic infiltrate, mycosis fungoides is often not part of initial differential considerations. However, eosinophilia has been described in certain subtypes of mycosis fungoides, namely, in folliculotropic mycosis fungoides. We describe three challenging cases of folliculotropic mycosis fungoides presenting with varied clinical morphologies and a dense lymphoeosinophilic infiltrate and/or severe hypereosinophilia that obscured the final diagnosis for years. Only after treatment of the eosinophilia were the underlying atypical lymphocytes more apparent on histology and a correct diagnosis made. Thus, when characteristic features of mycosis fungoides are subtle, eosinophils can act as a red herring in terms of clinico-pathologic correlation and may prevent early and accurate diagnosis of mycosis fungoides. We suggest that further studies are needed to evaluate whether treatments to reduce eosinophilia, once other causes have been excluded, may help clear the confounding reactive inflammatory infiltrate and facilitate the diagnosis of mycosis fungoides.
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Affiliation(s)
- Alejandra Jaque
- University of Toronto and Department of Medicine, Sunnybrook Hospital, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Alexandra Mereniuk
- University of Toronto and Department of Medicine, Sunnybrook Hospital, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Shachar Sade
- University of Toronto and Department of Pathology, Sunnybrook Hospital, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Perla Lansang
- University of Toronto and Department of Medicine, Sunnybrook Hospital, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Kevin Imrie
- University of Toronto and Department of Medicine, Sunnybrook Hospital, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Neil H Shear
- University of Toronto and Department of Medicine, Sunnybrook Hospital, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Mereniuk A, Jaque A, Jeschke MG, Shear NH. Toxic Epidermal Necrolysis Spectrum Management at Sunnybrook Health Sciences Centre: Our Multidisciplinary Approach After Review of the Current Evidence. J Cutan Med Surg 2017; 22:213-219. [PMID: 29202605 DOI: 10.1177/1203475417746148] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Toxic epidermal necrolysis spectrum (TENS) is a rare yet severe adverse drug reaction associated with a high mortality rate. Beyond supportive care, there is still no established therapy for TENS, although recent meta-analyses and UK guideline recommendations have attempted to offer a review of relevant literature on this difficult topic. As most directed treatments lack clear consensual evidence, care centres often resort to establishing their own strategies. As Canada's largest adult burn centre and the provincial reference centre for most burn patients in Ontario, our team at the Ross Tilley Burn Centre, in collaboration with the Department of Dermatology at Sunnybrook Health Sciences Centre, Toronto, Canada, has managed over 60 confirmed cases of TENS over the past 2 decades. We would like to share our management, experience, and present our treatment protocol that we recently established by a collaborative multidisciplinary team approach to help guide treatment of these complex patients not only in Canada but worldwide.
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Affiliation(s)
- Alexandra Mereniuk
- 1 Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Alejandra Jaque
- 1 Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Marc G Jeschke
- 2 Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Department of Immunology, Division of Plastic and Reconstructive Surgery, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Neil H Shear
- 1 Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
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Jaque A, Moll-Manzur C, Dossi MT, Berroeta-Mauriziano D, Araos-Baeriswyl E, Monsalve X. [Ecthyma gangrenosum caused by Staphylococcus aureus]. Rev Chilena Infectol 2016; 33:336-9. [PMID: 27598286 DOI: 10.4067/s0716-10182016000300015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 04/12/2016] [Indexed: 11/17/2022] Open
Abstract
Ecthyma gangrenosum is an uncommon necrotizing vasculitis, in most cases secondary to sepsis by Pseudo-mona aeruginosa in immunocompromised patients. However, there have been several reports of ecthyma gangre-nosum caused by other infectious etiologies. We report an unusual case of ecthyma gangrenosum associated with methicillin-resistant Staphylococcus aureus infection in a patient without the classic immunological risk factors described in the literature.
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Affiliation(s)
- Alejandra Jaque
- Departamento de Dermatología, Pontificia Universidad Católica de Chile, Chile,
| | | | - María Teresa Dossi
- Departamento de Dermatología, Pontificia Universidad Católica de Chile, Chile
| | | | | | - Ximena Monsalve
- Departamento de Medicina Interna, Pontificia Universidad Católica de Chile, Chile
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Molgó M, Jaque A, Vial V, Ocqueteau M, Pereira J, Chang M, González S. [Sézary syndrome treated with extracorporeal photopheresis: Report of one case]. Rev Med Chil 2016; 143:1449-58. [PMID: 26757870 DOI: 10.4067/s0034-98872015001100011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 07/15/2015] [Indexed: 11/17/2022]
Abstract
Sézary syndrome (SS) is an unusually aggressive T- cell lymphoma characterized by the triad of erythroderma, the presence of more than 1,000 Sézary cells in peripheral blood and lymphadenopathies. It is accompanied by generalized pruritus and poor quality of life. The management of SS depends on its stage, patient comorbidities, and treatment availability. Extracorporeal photopheresis (ECP) is the first line of treatment for patients with T-cell lymphomas in stage IVA1, IVA2 or SS. This treatment comprises three phases: leukapheresis, photoactivation and subsequent reinfusion of lymphocytes. As it is an immunomodulatory therapy it does not produce generalized immunosuppression. We report a 76 year-old male with SS stage IIIb initially treated with 12 sessions of ultraviolet phototherapy without response. After 10 well-tolerated sessions of ECP, itching and skin lesions eventually disappeared.
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Antúnez-Lay A, Jaque A, González S. Hemorrhagic bullous skin lesions. Int J Dermatol 2015; 56:145-147. [PMID: 26710755 DOI: 10.1111/ijd.13184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Revised: 08/13/2015] [Accepted: 08/21/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Andrea Antúnez-Lay
- School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alejandra Jaque
- Department of Dermatology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Sergio González
- Department of Pathology, Pontificia Universidad Católica de Chile, Santiago, Chile
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Navarrete-Dechent C, Puerto CD, Bajaj S, Marghoob AA, González S, Jaque A. Dermoscopy of elastosis perforans serpiginosa: A useful tool to distinguish it from granuloma annulare. J Am Acad Dermatol 2015; 73:e7-9. [PMID: 26089077 DOI: 10.1016/j.jaad.2015.02.1132] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2014] [Revised: 02/04/2015] [Accepted: 02/24/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Cristián Navarrete-Dechent
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Constanza del Puerto
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Shirin Bajaj
- Dermatology Service, Memorial Sloan Kettering Cancer Center, Hauppauge, New York
| | - Ashfaq A Marghoob
- Dermatology Service, Memorial Sloan Kettering Cancer Center, Hauppauge, New York
| | - Sergio González
- Department of Pathology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alejandra Jaque
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
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Hansen JL, Jaque A, Wyhe F. [Preoperative pathoanatomical diagnosis of bronchogenic carcinoma. The valve of traditional and new methods]. Ugeskr Laeger 1977; 139:2797-2800. [PMID: 595166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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