Metastatic hidradenocarcinoma: a report of two rare cases.

BACKGROUND: Hidradenocarcinoma is a rare malignant sweat gland tumour, characterized by a slow but aggressive course, with high rates of local recurrence and metastasis. Due to its rarity, histological criteria and therapeutic guidelines are poorly defined, posing a major challenge for clinicians and pathologists. OBJECTIVES: To present two new cases of metastatic hidradenocarcinoma as well as a review of the literature. MATERIALS & METHODS: We describe two case studies and a review of the literature based on a search using the MEDLINE (PubMed) electronic database. RESULTS: The first patient was a 61-year-old woman with a perimamillary hidradenocarcinoma that arose from the malignant transformation of a benign childhood lesion and developed regional lymph node metastases after wide excision and adjuvant radiotherapy. The second patient was a 63-year-old man who developed cutaneous and renal metastases several years after the complete excision of a lumbar hidradenocarcinoma. As far as we can ascertain, kidney metastasis from hidradenocarcinoma has not previously been described. CONCLUSION: Most authors recommend wide excision as the treatment of choice for hidradenocarcinoma, however, optimal adjuvant therapy remains to be determined. Our cases add to the limited knowledge available, but high-quality studies to find new effective treatments are needed.

Effects of ownership patterns on cross-boundary wildfires.

Understanding ownership effects on large wildfires is a precursor to the development of risk governance strategies that better protect people and property and restore fire-adapted ecosystems. We analyzed wildfire events in the Pacific Northwest from 1984 to 2018 to explore how area burned responded to ownership, asking whether particular ownerships burned disproportionately more or less, and whether these patterns varied by forest and grass/shrub vegetation types. While many individual fires showed indifference to property lines, taken as a whole, we found patterns of disproportionate burning for both forest and grass/shrub fires. We found that forest fires avoided ownerships with a concentration of highly valued resources-burning less than expected in managed US Forest Service forested lands, private non-industrial, private industrial, and state lands-suggesting the enforcement of strong fire protection policies. US Forest Service wilderness was the only ownership classification that burned more than expected which may result from the management of natural ignitions for resource objectives, its remoteness or both. Results from this study are relevant to inform perspectives on land management among public and private entities, which may share boundaries but not fire management goals, and support effective cross-boundary collaboration and shared stewardship across all-lands.

Clinical ABCDE rule for early melanoma detection.

BACKGROUND: The ABCDE rule systematizes warning signs for malignant melanoma (MM). OBJECTIVES: To evaluate whether the ABCDE signs are associated with early detection of MM. MATERIALS & METHODS: Based on a retrospective study over 11.5 years, we assessed whether ABCDE signs are associated with early diagnosis of MM. RESULTS: In total, 144 MM were included; 52 (36.1%) in situ and 92 (63.9%) invasive lesions. For 23.6%, the MM were first suspected by an individual other than a dermatologist. The "E sign" was significantly less frequent among in situ lesions (32.7% versus 50.0%; p = 0.044). Based on adjusted analyses, the probability of MM being first suspected by a non-dermatologist consistently increased with the number of ABCDE signs of the lesion, ranging from 8% for a neoplasm with no ABCDE signs to 32% for a lesion with five signs (OR = 1.6; 95% CI: 1.2-2.2; p = 0.004). CONCLUSION: A higher number of ABCDE signs were associated with a greater chance of MM being first suspected by a non-dermatologist, but not in situ MM diagnosis. Relying on the ABCDE rule alone might result in missing early MM lesions.

Assessing Transboundary Wildfire Exposure in the Southwestern United States.

We assessed transboundary wildfire exposure among federal, state, and private lands and 447 communities in the state of Arizona, southwestern United States. The study quantified the relative magnitude of transboundary (incoming, outgoing) versus nontransboundary (i.e., self-burning) wildfire exposure based on land tenure or community of the simulated ignition and the resulting fire perimeter. We developed and described several new metrics to quantify and map transboundary exposure. We found that incoming transboundary fire accounted for 37% of the total area burned on large parcels of federal and state lands, whereas 63% of the area burned was burned by ignitions within the parcel. However, substantial parcel to parcel variation was observed for all land tenures for all metrics. We found that incoming transboundary fire accounted for 66% of the total area burned within communities versus 34% of the area burned by self-burning ignitions. Of the total area burned within communities, private lands contributed the largest proportion (36.7%), followed by national forests (19.5%), and state lands (15.4%). On average seven land tenures contributed wildfire to individual communities. Annual wildfire exposure to structures was highest for wildfires ignited on state and national forest land, followed by tribal, private, and BLM. We mapped community firesheds, that is, the area where ignitions can spawn fires that can burn into communities, and estimated that they covered 7.7 million ha, or 26% of the state of Arizona. Our methods address gaps in existing wildfire risk assessments, and their implementation can help reduce fragmentation in governance systems and inefficiencies in risk planning.

Network analysis of wildfire transmission and implications for risk governance.

We characterized wildfire transmission and exposure within a matrix of large land tenures (federal, state, and private) surrounding 56 communities within a 3.3 million ha fire prone region of central Oregon US. Wildfire simulation and network analysis were used to quantify the exchange of fire among land tenures and communities and analyze the relative contributions of human versus natural ignitions to wildfire exposure. Among the land tenures examined, the area burned by incoming fires averaged 57% of the total burned area. Community exposure from incoming fires ignited on surrounding land tenures accounted for 67% of the total area burned. The number of land tenures contributing wildfire to individual communities and surrounding wildland urban interface (WUI) varied from 3 to 20. Community firesheds, i.e. the area where ignitions can spawn fires that can burn into the WUI, covered 40% of the landscape, and were 5.5 times larger than the combined area of the community core and WUI. For the major land tenures within the study area, the amount of incoming versus outgoing fire was relatively constant, with some exceptions. The study provides a multi-scale characterization of wildfire networks within a large, mixed tenure and fire prone landscape, and illustrates the connectivity of risk between communities and the surrounding wildlands. We use the findings to discuss how scale mismatches in local wildfire governance result from disconnected planning systems and disparate fire management objectives among the large landowners (federal, state, private) and local communities. Local and regional risk planning processes can adopt our concepts and methods to better define and map the scale of wildfire risk from large fire events and incorporate wildfire network and connectivity concepts into risk assessments.

Nail melanoma in situ: clinical, dermoscopic, pathologic clues, and steps for minimally invasive treatment.

BACKGROUND: Nail unit melanoma (NUM) is a variant of acral lentiginous melanoma. The differential diagnosis is wide but an acquired brown streak in the nail of a fair-skinned adult person must be considered a potential melanoma. Dermoscopy helps clinicians to more accurately decide if a nail apparatus biopsy is necessary. OBJECTIVE: Detailed evaluation of clinical and dermoscopy features and description of conservative surgery of in situ NUM. METHODS: Retrospective study of in situ NUM diagnosed and treated with conservative surgical management in the authors' center from 2008 to 2013. RESULTS: Six cases of NUM were identified: 2 male and 4 female patients, age range at diagnosis of 44 to 76 years. All patients underwent complete nail unit removal with at least 6-mm security margins around the anatomic boundaries of the nail. The follow-up varies from 4 to 62 months. CONCLUSION: Nail unit melanomas pose a difficult diagnostic and therapeutic challenge. Wide excision is sufficient, whereas phalanx amputation is unnecessary and associated with significant morbidity for patients with in situ or early invasive melanoma. Full-thickness skin grafting or second-intention healing after total nail unit excision is a simple procedure providing a good functional and cosmetic outcome.

Wildfire selectivity for land cover type: does size matter?

Previous research has shown that fires burn certain land cover types disproportionally to their abundance. We used quantile regression to study land cover proneness to fire as a function of fire size, under the hypothesis that they are inversely related, for all land cover types. Using five years of fire perimeters, we estimated conditional quantile functions for lower (avoidance) and upper (preference) quantiles of fire selectivity for five land cover types - annual crops, evergreen oak woodlands, eucalypt forests, pine forests and shrublands. The slope of significant regression quantiles describes the rate of change in fire selectivity (avoidance or preference) as a function of fire size. We used Monte-Carlo methods to randomly permutate fires in order to obtain a distribution of fire selectivity due to chance. This distribution was used to test the null hypotheses that 1) mean fire selectivity does not differ from that obtained by randomly relocating observed fire perimeters; 2) that land cover proneness to fire does not vary with fire size. Our results show that land cover proneness to fire is higher for shrublands and pine forests than for annual crops and evergreen oak woodlands. As fire size increases, selectivity decreases for all land cover types tested. Moreover, the rate of change in selectivity with fire size is higher for preference than for avoidance. Comparison between observed and randomized data led us to reject both null hypotheses tested ([Formula: see text] = 0.05) and to conclude it is very unlikely the observed values of fire selectivity and change in selectivity with fire size are due to chance.