A Case of Auricular Pseudocyst.

BACKGROUND: Auricular pseudocyst is a rare, asymptomatic, cystic-like swelling of the auricle that may pose a diagnostic challenge to the clinician. If inadequately treated, recurrences and ear deformities may ensue. OBJECTIVE: The authors present a case of auricular pseudocyst in a previously healthy 43-year-old man. Aetiologies, histology, differential diagnosis, and treatment modalities are discussed.

Clinical, Dermoscopic, and Molecular Features of Acantholytic Squamous Cell Carcinoma: A Systematic Review.

INTRODUCTION: Acantholytic squamous cell carcinoma (aSCC) is a rare clinicopathological subtype of cutaneous squamous cell carcinoma, accounting for approximately 4.9% of all SCC cases. However, there are currently no standardized criteria for the diagnosis of aSCC. This systematic review is the first to summarize the clinical and molecular features of aSCC. METHODS: A systematic search of Medline, Embase, Scopus, and PubMed was performed. All articles in English or French were included, with no restriction of publication date. All articles with original data pertaining to clinical or molecular characteristics of aSCC were included. Two reviewers screened articles and resolved conflicts. RESULTS: Our systematic review included 52 studies on the clinical and molecular features of aSCC, including a total of 482 patients (76% male, mean age at diagnosis 68.9 years): 430 cases assessed clinical features, while 149 cases assessed molecular features. The most common location of aSCC was the head and neck (n = 329/430; 76.5%). In terms of morphology, most lesions were described as nodules (n = 93/430, 21.6%), with common surface changes being hyperkeratosis (n = 6), erosion (n = 6), ulceration (n = 5), and crusting (n = 3). With regard to dermoscopy, only six cases were noted in the literature, including findings such as ulceration (n = 3), keratin clots (n = 2), and erosions (n = 2). Thirty-four studies discussed the molecular markers of aSCC, with the most prevalent markers being cytokeratins. CD15 negativity was noted in 23 cases, while common endothelial vascular markers such as CD34 (n = 16), CD31 (n = 15), factor VIII-related antigen (n = 10), and ERG (n = 1) were often not expressed. Finally, expression of intracellular adhesion molecules (i.e., E-cadherin, CD138) was markedly decreased compared to non-acantholytic invasive SCC. CONCLUSIONS: This systematic review summarizes the clinical characteristics and molecular features of aSCC. As clinical differentiation can be difficult, clinicopathological correlation with molecular markers may help ensure proper diagnosis.

Connective tissue nevi in children: institutional experience and review.

BACKGROUND: Connective tissue nevi (CTN) are circumscribed hamartomas of the skin in which there is an abnormal mixture of normal components of the dermis that may be sporadic or associated with syndromes such as Buschke-Ollendorff, tuberous sclerosis, and Proteus. OBJECTIVE: We sought to specify the clinical and histologic features of CTN in childhood and to propose a diagnostic approach and updated classification. METHODS: This was a retrospective study in a tertiary pediatric outpatient population, accessing clinical and histopathological records. RESULTS: We classified 114 cases of CTN from 1980 to 2008. LIMITATIONS: The majority of cases were confirmed by histopathological examination. Therefore, our series excludes many CTN that were not biopsied. In addition, follow-up was variable. CONCLUSION: Our series demonstrates the usefulness of a modified classification for CTN. Biopsy should be done when clinical diagnosis is uncertain, or in multiple lesions. When biopsy is performed it should include normal-appearing skin for comparison and, in Buschke-Ollendorff syndrome, limited anterior-posterior x-rays of the hands, wrists, feet, ankles, knees, and pelvis instead of a full skeletal survey.

Physician survey regarding patient nonattendance at follow-up appointments at a university-affiliated medical dermatology clinic.

BACKGROUND: Patient nonattendance is a frequent occurrence in dermatology clinics, and our responsibility regarding the follow-up of these patients remains nebulous. OBJECTIVE: This study sought to evaluate the beliefs and practices of physicians at a university-affiliated medical dermatology clinic regarding patient nonattendance at follow-up appointments and to provide an algorithm to deal appropriately with absentee patients based on various Canadian medical association guidelines. METHODS: A questionnaire was distributed to the 17 dermatologists practicing at the Centre Hospitalier de l'Université de Montréal medical dermatology clinic. We contacted provincial and national medical associations regarding directives for patient follow-up. RESULTS: There is a lack of consensus among dermatologists at the Centre Hospitalier de l'Université de Montréal regarding responsibility toward patients who miss their follow-up appointments. However, the majority of survey respondents consider that patient follow-up must be adjusted on a case-by-case basis and that diagnoses at risk for high morbidity and mortality require particular attention, which is in line with various Canadian medical association guidelines. CONCLUSION: Dermatologists should have a structured approach to dealing with patients who miss their follow-up appointments to ensure the appropriate care of all patients.

Histopathologic evaluation of cutaneous squamous cell carcinoma: results of a survey among dermatopathologists.

BACKGROUND: There are numerous histopathologic features related to prognosis in cutaneous squamous cell carcinoma (CSCC). We hypothesize that there is no uniform approach toward the reporting of these features. This may be related to differing opinions on their prognostic use. METHODS: A written survey concerning the microscopic evaluation of CSCC was sent to 120 dermatopathologists in the United States and Canada. Respondents were asked whether they comment on specific microscopic features of CSCC, and whether they believe that each specific feature can predict prognosis. RESULTS: The response rate was 78%. Histologic type, and the presence of perineural or vascular/lymphatic invasion, is reported by most dermatopathologists (90%, 96%, and 95%, respectively). These features are also thought to predict prognosis by the majority of respondents. Only 54% report histologic grade, and 49% think grade predicts prognosis. Depth is reported anatomically by 63%, but by only 8% in actual millimeters of invasion. However, 55% think tumor depth predicts prognosis. A total of 43% report the presence of an associated actinic keratosis, although very few (16%) think it predicts prognosis. Very few comment on the presence of inflammation. CONCLUSIONS: Histopathologic reporting of CSCC is not uniform among dermatopathologists. Also, there appears to be differing opinions on the use of certain histopathologic features for predicting prognosis.