Recent-onset bloody nodule.

An antibiotic ointment failed to clear the lesion on the patient's back. A more detailed history revealed the nodule's troubling genesis.

Depth of Invasion of Aggressive and Nonaggressive Basal Cell Carcinoma.

Objective: Dermal invasion is characteristic of more aggressive basal cell carcinoma (BCC) tumors. However, reporting the depth of invasion of BCC is not currently a standard or recommended practice. The purpose of this study was to document the depth of invasion of BCC. Design: Original hematoxylin and eosin-stained slides of biopsied BCCs (N=500) were reviewed. The depth of invasion was measured for each case. Each case was also determined to be aggressive or nonaggressive based on the presence of additional histologic features. Setting: Biopsy specimens from a large private practice were reviewed. Measurements: Descriptive statistics were calculated for all cases. To compare the average depth of invasion of cases with aggressive features versus cases with nonaggressive features, two-tailed, independent t-tests were computed. Results: The overall median depth of invasion was 0.68mm (range: 0.10-5.49). The median depth of invasion of aggressive cases (n=68) was 1.04mm, while the median depth of invasion of nonaggressive cases (n=432) was 0.62mm. The difference between median depth of invasion of aggressive and nonaggressive cases was found to be significant (p<0.0001). This significant difference (p<0.0001) was maintained even with transection, which was present in the majority of cases (n=347; 69.4%). Conclusions: Dermal invasion depths of all subtypes of BCC have not been previously reported. The median dermal invasion of histologically aggressive BCC is greater than nonaggressive tumors. These findings might help clinicians in determining the depth of biopsy and choice of treatment.

Metastatic squamous cell carcinoma of the skin with clinical response to lapatinib.

BACKGROUND: Lapatinib is a tyrosine kinase inhibitor that blocks the HER2 receptor and is typically used in the setting of metastatic breast cancer. Both ERBB2 (HER2) and ERBB3 (HER3) belong to the same family of receptor tyrosine kinases. Dimerization of these receptors leads to activation of cell proliferation and survival pathways, granting oncogenic potential to dysregulated ERBB/HER receptors. Next generation sequencing (NGS) of tumors has ushered in a new era of personalized oncology therapy and has the ability to detect mutations in ERBB receptors. CASE PRESENTATION: We present a patient with metastatic cutaneous squamous cell carcinoma who failed surgery, radiation, and anti-PD1 therapy, but showed clinical response to a drug targeting an ERBB3 mutation identified with NGS. Following initiation of the drug lapatinib, this patient exhibited dramatic tumor regression in the skin, soft tissue, bone and nerves. CONCLUSIONS: Cutaneous squamous cell carcinoma is the 2nd most common skin cancer in humans and future investigation of ERBB2 targeted therapies may provide an effective treatment strategy for patients with mutations in the ERBB2/3 pathway.

CK7 negative anaplastic thyroid carcinoma presenting as cutaneous metastases to the scalp.

Anaplastic thyroid carcinoma (ATC) is an extremely rare but aggressive form of thyroid cancer. Although local tissue invasion is characteristic of this disease, systemic metastases are a common clinical finding. Our case discusses an unusual presentation of cutaneous metastases to the scalp in a patient with a remote history of ATC. It also highlights the utility of immunohistochemical staining in determining the origin of a tumor when the source of primary malignancy is not readily identifiable.

Generalized linear IgA dermatosis with palmar involvement.

Linear IgA bullous dermatosis (LABD) is a sub-epidermal blistering disorder characterized by deposition of IgA along the basement membrane zone (BMZ) as detected by immunofluorescence microscopy. The diagnosis is made by clinicopathologic correlation with immunofluorescence confirmation. Differentiation from other bullous dermatoses is important because therapeutic measures differ. Prompt initiation of the appropriate therapies can have a major impact on outcomes. We present three cases with prominent palmar involvement to alert the clinician of this potential physical exam finding and to consider LABD in the right context.