How informative are dermatopathology requisition forms completed by dermatologists? A review of the clinical information provided for 100 consecutive melanocytic lesions.

BACKGROUND: Accurate clinicopathologic correlation can be crucial to arriving at the correct microscopic diagnosis. OBJECTIVE: We reviewed the clinical information provided on the dermatopathology requisition forms for melanocytic lesions submitted by community dermatologists. METHODS: The clinical information provided and the microscopic diagnoses rendered were recorded in a retrospective, unblinded fashion for 100 consecutive melanocytic lesions submitted as wet tissue to our dermatopathology department. RESULTS: Biopsy specimens were received from 60 community dermatologists and 5 nurse practitioners/physician assistants. Clinical morphology (ie, papule) was provided in 33% of cases. With respect to the ABCDE criteria, 55% of cases had none, 12% had one criterion, 21% had two criteria, 10% had 3 criteria, 2% had 4 criteria, and none had all 5 criteria. No forms stated whether the biopsy specimen was a partial or complete sampling of the lesion. Asymmetry was provided 4% of the time, border irregularity 8%, color 39%, diameter 22%, and evolution 10%. A family or personal history of melanoma was provided in 8% of cases. No requisition forms mentioned the "ugly duckling" sign. Dermatoscopy information and a clinical photograph were provided once each. In 19 cases, the only information on the requisition form was one of the phrases: "r/o atypia," "r/o atypical nevus," "r/o Clark's," or "r/o dysplastic nevus." In 10 cases, the only information was "r/o nevus." LIMITATIONS: Only 100 consecutive melanocytic lesions were studied in a retrospective, unblinded fashion. CONCLUSION: Important clinical information regarding pigmented lesions is often not provided on the requisition form. Potential reasons for this deficit and suggestions for improvement are discussed.

Unraveling the paradoxes of HIV-associated psoriasis: a review of T-cell subsets and cytokine profiles.

HIV-associated psoriasis appears paradoxical, being a T-cell mediated disease in the face of decreasing T-cell counts. Furthermore, psoriasis is generally mediated by type-1 cytokines, whereas in HIV, type-2 cytokines tend to predominate. How can one have psoriasis in the essentially Th2 environment of HIV? The details and pertinent research regarding T cell subsets and cytokine profiles in psoriasis, HIV, and HIV-associated psoriasis were reviewed. It appears that both in the presence and absence of HIV infection, psoriasis is largely mediated by memory CD8 T cells, and that IFN-gamma secreted by these cells and others is of key importance. Studying psoriasis in a model such as HIV in which certain elements of the immune system are stripped away or altered may help us better understand the pathogenic mechanisms and potential treatment targets for psoriasis vulgaris.

Multiple significant bortezomib-related toxicities in one patient: case report and literature review.

Bortezomib has shown significant efficacy in the treatment of patients with relapsed multiple myeloma (MM) and is generally well tolerated. We report a 65-year-old male patient undergoing bortezomib therapy for MM who, with the addition of liposomal doxorubicin, presented with severe paralytic ileus, peripheral neuropathy, pruritic rash, and testicular pain. Each of these toxicities was temporally related to the bortezomib-based therapy and the administration of concomitant liposomal doxorubicin. Herein, we discuss the patient's course and briefly review the literature on these bortezomib combination-related toxicities.

Age and skin structure and function, a quantitative approach (II): protein, glycosaminoglycan, water, and lipid content and structure.

BACKGROUND/PURPOSE: The aging process has been studied with fervor recently, given our shifting demographics. As age's effects are so manifest in the skin's appearance, structure, mechanics, and barrier function, it is not surprising that much effort has been made in research to better understand them. Quantitative measurements permitted by bioengineering have allowed us to objectively and precisely study aging skin. These overviews piece together the immense amounts of information that have emerged from recent technological advances in dermatological research in order to develop a unified understanding of the quantitative effects of age on skin. METHODS: We performed a literature search on age-related changes in protein, glycosaminoglycan (GAG), water, and lipid content and structure, searching Pub-med, Em-Base, Science Citation Index, and the UCSF dermatological library's collection of books on the topic of aging skin. RESULTS: Collagen becomes sparser and less soluble in intrinsically aged skin, but is thickened and more soluble in extrinsically aged areas. Elastin is degraded slowly and accumulates damage with intrinsic aging; also, increased synthesis of abnormally structured elastin occurs in photoexposed areas. This leads to an age-related accumulation of aberrant elastoic material, clumped in the papillary dermis. Generally, age leads to increased folding and decreased interaction of proteins with water. Also, despite increased GAGs in aged skin, these are abnormally deposited on the elastoic material and cannot interact properly with water. Hence, in aged skin, water is found in the tetrahedron form, bound to itself rather than other molecules. Lipid content appears to decrease with age, although the proportion of different lipid classes seems to remain fairly constant. CONCLUSION: Much work remains to be carried out to reach a consensus on the effects of age on skin structure and function. Future studies would be benefited by increased standardization of skin sites tested, methodology, and increased sample sizes.

Age and skin structure and function, a quantitative approach (I): blood flow, pH, thickness, and ultrasound echogenicity.

BACKGROUND/PURPOSE: The aging process has been studied with fervor recently, given our shifting demographics. Since age's effects are so manifest in skin's appearance, structure, mechanics, and barrier function, it is not surprising that much effort has been placed in research to better understand them. Quantitative measurements permitted by bioengineering have allowed us to objectively and precisely study aging skin. These overviews piece together the immense amounts of information that have emerged from recent technological advances in dermatological research in order to develop a unified understanding of the quantitative effects of age on the skin. METHODS: We performed a literature on age-related changes in blood flow, pH, skin thickness, and ultrasound imaging data, searching Pub-med, Em-Base, Science Citation Index, and the UCSF dermatological library's collection of books on the topic of aging skin. RESULTS: Despite the many tools and techniques available for quantitative analysis of skin, age studies are often conflicting, especially in the areas of blood flow and skin thickness. Trends indicate that blood flow may decrease with age, especially in sites exposed to the environment. pH apparently varies little until the age of 70, after which it declines. Skin thickness data are difficult to interpret; while the stratum corneum is generally accepted to maintain its thickness during aging, dermal, epidermal, and whole skin thickness changes are controversial. Ultrasound reveals the appearance of a subepidermal low echogenic band that thickens with age, especially in environmentally exposed areas. Some studies also indicate the presence of an echogenic band in the lower dermis which thins with increased age. However, the whole dermis appears to become more echogenic in elderly people. CONCLUSION: Much remains to be done if we are to reach consensus on the effects of age on skin structure and function. Future studies would be benefited by increased standardization of skin sites tested, methodology, and increased sample size.