Correspondence
Dakar, Senegal: a common and potentially hazardous practice. Trans R Soc Trop Med Hyg 2007; 101: 183–187.
Cardiovascular aspects of psoriasis: an updated review
We read with great interest the systematic review and meta-analysis by Pietrzak et al.1 We agree with the conclusion of their paper, i.e., that patients with psoriasis are at increased risk of cardiovascular events. Along this line, our nationwide Danish cohort studies have demonstrated that psoriasis is associated with an increased risk of death, cardiovascular death, myocardial infarction, stroke, coronary revascularization, and venous thromboembolism.2,3 Therefore, we were surprised to see that in the Pietrzak et al. meta-analysis, our results appeared to not support the association between psoriasis and adverse cardiovascular events.1 In our opinion, however, the authors misinterpreted our data and (a) it is unclear from their meta-analysis which events were classified as cardiovascular events, e.g., venous thromboembolism was not mentioned in the text; (b) the data apparently used by Pietrzak et al. from our papers to calculate odds ratios for cardiovascular events actually were not those from our prespecified endpoints but rather represented data from our baseline study populations (from which patients with prevalent psoriasis and previous cardiovascular disease were excluded); and (c) the authors appear to have disregarded that our patients with psoriasis had significantly higher incidence rates and incidence rate ratios for all prespecified cardiovascular endpoints.2,3 Therefore, we support the conclusions of Pietrzak et al.1 but do not agree with their interpretation of our results.2,3 Ole Ahlehoff, MD, PhD Department of Cardiology Copenhagen University Hospital Roskilde
A rare case of vulvar skin metastasis of rectal cancer after surgery
To the Editor: We read with great interest the article by Hoyt and Cohen,1 in which the authors presented a case of cutaneous scrotal metastasis. Cutaneous metastases from carcinoma are relatively uncommon in clinical practice. They usually occur in the surgical region and rarely present at other sites.2 The most frequent site of colorectal cancer metastasis is the liver, followed by the lung. In contrast, vulvar metastases are exceptional. We would like to share our experience of a patient with vulvar skin metastasis of rectal adenocarcinoma. This patient was a 47-year-old woman ª 2014 The International Society of Dermatology
6 Del Giudice P, Raynaud E, Mahe A. Cosmetic use of skin depigmentation products in Africa. Bull Soc Pathol Exot 2003; 96: 389–393.
Roskilde Denmark Gunnar Gislason, MD, PhD Department of Cardiology Copenhagen University Hospital Gentofte Hellerup Denmark Peter R. Hansen, MD, DMSC, PhD Department of Cardiology Copenhagen University Hospital Gentofte Hellerup Denmark Ole Ahlehoff, MD, PhD Department of Cardiology Copenhagen University Hospital Gentofte DK-2900 Denmark E-mail: [email protected] References 1 Pietrzak A, Bartosi nska J, Chodorowska G, et al. Cardiovascular aspects of psoriasis: an updated review. Int J Dermatol 2013; 52: 153–162. 2 Ahlehoff O, Gislason GH, Charlot M, et al. Psoriasis is associated with clinically significant cardiovascular risk: a Danish nationwide cohort study. J Intern Med 2011; 270: 147–157. 3 Ahlehoff O, Gislason GH, Lindhardsen J, et al. Psoriasis carries an increased risk of venous thromboembolism: a Danish nationwide cohort study. PLoS One 2011; 6: e18125.
who underwent abdominoperineal resection, with resection of ovarian metastases three years earlier. The patient presented to us with a palpable mass in the right vulvar region. On physical examination, the patient had an ulcerated, erythematous, 1 9 1.5 cm nodule that extended from the skin into the subcutaneous fat in the right of the vulvar region (Fig. 1). Carcinoembryonic antigen elevation was also found. Abdominal magnetic resonance imaging scan showed increased signal areas adjacent to the right of the vulva. A surgical excision of the vulvar lesion was performed. Carcinoma composed of atypical glandular structures infiltrating vulvar skin was seen under microscopic examination (Fig. 2). The patient was referred to the medical oncology International Journal of Dermatology 2014, 53, e332–e346
e337
Dakar, Senegal: a common and potentially hazardous practice. Trans R Soc Trop Med Hyg 2007; 101: 183–187.
Cardiovascular aspects of psoriasis: an updated review
We read with great interest the systematic review and meta-analysis by Pietrzak et al.1 We agree with the conclusion of their paper, i.e., that patients with psoriasis are at increased risk of cardiovascular events. Along this line, our nationwide Danish cohort studies have demonstrated that psoriasis is associated with an increased risk of death, cardiovascular death, myocardial infarction, stroke, coronary revascularization, and venous thromboembolism.2,3 Therefore, we were surprised to see that in the Pietrzak et al. meta-analysis, our results appeared to not support the association between psoriasis and adverse cardiovascular events.1 In our opinion, however, the authors misinterpreted our data and (a) it is unclear from their meta-analysis which events were classified as cardiovascular events, e.g., venous thromboembolism was not mentioned in the text; (b) the data apparently used by Pietrzak et al. from our papers to calculate odds ratios for cardiovascular events actually were not those from our prespecified endpoints but rather represented data from our baseline study populations (from which patients with prevalent psoriasis and previous cardiovascular disease were excluded); and (c) the authors appear to have disregarded that our patients with psoriasis had significantly higher incidence rates and incidence rate ratios for all prespecified cardiovascular endpoints.2,3 Therefore, we support the conclusions of Pietrzak et al.1 but do not agree with their interpretation of our results.2,3 Ole Ahlehoff, MD, PhD Department of Cardiology Copenhagen University Hospital Roskilde
A rare case of vulvar skin metastasis of rectal cancer after surgery
To the Editor: We read with great interest the article by Hoyt and Cohen,1 in which the authors presented a case of cutaneous scrotal metastasis. Cutaneous metastases from carcinoma are relatively uncommon in clinical practice. They usually occur in the surgical region and rarely present at other sites.2 The most frequent site of colorectal cancer metastasis is the liver, followed by the lung. In contrast, vulvar metastases are exceptional. We would like to share our experience of a patient with vulvar skin metastasis of rectal adenocarcinoma. This patient was a 47-year-old woman ª 2014 The International Society of Dermatology
6 Del Giudice P, Raynaud E, Mahe A. Cosmetic use of skin depigmentation products in Africa. Bull Soc Pathol Exot 2003; 96: 389–393.
Roskilde Denmark Gunnar Gislason, MD, PhD Department of Cardiology Copenhagen University Hospital Gentofte Hellerup Denmark Peter R. Hansen, MD, DMSC, PhD Department of Cardiology Copenhagen University Hospital Gentofte Hellerup Denmark Ole Ahlehoff, MD, PhD Department of Cardiology Copenhagen University Hospital Gentofte DK-2900 Denmark E-mail: [email protected] References 1 Pietrzak A, Bartosi nska J, Chodorowska G, et al. Cardiovascular aspects of psoriasis: an updated review. Int J Dermatol 2013; 52: 153–162. 2 Ahlehoff O, Gislason GH, Charlot M, et al. Psoriasis is associated with clinically significant cardiovascular risk: a Danish nationwide cohort study. J Intern Med 2011; 270: 147–157. 3 Ahlehoff O, Gislason GH, Lindhardsen J, et al. Psoriasis carries an increased risk of venous thromboembolism: a Danish nationwide cohort study. PLoS One 2011; 6: e18125.
who underwent abdominoperineal resection, with resection of ovarian metastases three years earlier. The patient presented to us with a palpable mass in the right vulvar region. On physical examination, the patient had an ulcerated, erythematous, 1 9 1.5 cm nodule that extended from the skin into the subcutaneous fat in the right of the vulvar region (Fig. 1). Carcinoembryonic antigen elevation was also found. Abdominal magnetic resonance imaging scan showed increased signal areas adjacent to the right of the vulva. A surgical excision of the vulvar lesion was performed. Carcinoma composed of atypical glandular structures infiltrating vulvar skin was seen under microscopic examination (Fig. 2). The patient was referred to the medical oncology International Journal of Dermatology 2014, 53, e332–e346
e337
