Metastatic laryngeal carcinoma mimicking eruptive keratoacanthomas: report of keratoacanthoma-like cutaneous metastases in a radiation port.

Metastatic skin lesions from a primary squamous cell carcinoma of the head and neck have only been reported in 1%-2% of these patients. Hence, skin metastases from laryngeal carcinoma are uncommon. Also, cutaneous metastases clinically presenting as a keratoacanthoma are rare. We describe cutaneous metastases in a radiation port clinically mimicking eruptive keratoacanthomas. Using the PubMed database, an extensive literature search was performed using the keywords cancer, carcinoma, keratoacanthoma, laryngeal, metastases, metastasis, metastatic, mimicking, port, radiation, radiotherapy, radiation, skin, visceral. We were able to summarize the features of patients with keratoacanthoma-like cutaneous metastases and discuss radiation port cutaneous metastases. Cutaneous metastases can be the initial manifestation of a previously undiagnosed malignancy or can present in a patient with an established diagnosis of cancer. Our patient not only developed skin metastases that mimicked eruptive keratoacanthomas, but to the best of our knowledge, is the first individual to develop radiation port cutaneous metastasis from a primary laryngeal carcinoma. The development of cutaneous metastases in an area of skin that has been treated with radiation therapy may result from the treatment altering and/or injuring the site, thereby making it more susceptible to another condition, such as metastatic skin tumors. In patients with an established diagnosis of visceral malignancy, the appearance of new keratoacanthoma-like lesions should prompt the clinician to consider a biopsy in order to establish or exclude the possibility of a cutaneous metastasis.

Possible association between maternal lithium therapy and premature closure of the arterial duct. A case report.

BACKGROUND: Frequent causes of premature ductal closure include spontaneous idiopathic closure in utero and maternal use of nonsteroidal anti-inflammatory drugs late in pregnancy. CASE: We describe a case of a preterm infant born to a mother treated with lithium throughout pregnancy who presented with right-sided cardiac enlargement at 18 weeks' gestation. Immediately following delivery, echocardiography demonstrated a small closing patent arterial duct. CONCLUSION: We recommend that serial fetal echocardiography with emphasis on Doppler interrogation of the patent arterial duct be performed whenever a pregnant woman is taking lithium. The interrogation of the patent arterial duct is particularly important if right-sided chamber enlargement is noted at fetal sonography as this finding can be an early manifestation of premature ductal constriction.

Facial rejuvenation: combining cosmeceuticals with cosmetic procedures.

Cosmetic patients are looking for a more youthful appearance without spending a lot of money, feeling any pain, or experiencing any postprocedure downtime. New cosmeceutical therapies can be used adjuvant to chemical peels, lasers, and injectables, making antiaging regimens less painful and requiring less postprocedural healing time. Adjunctive agents can be used to enhance chemical peels and decrease postinflammatory hyperpigmentation (PIH). Topical retinoids used prior to ablative laser treatments can aid in faster postprocedure healing and reepithelialization. Cosmeceuticals that contain both antioxidants and anti-inflammatories can help reduce postprocedure inflammation. Acetyl hexapeptide-3 is an effective topical agent for decreasing wrinkles and can be used as an adjunct to intramuscular botulinum neurotoxin, which may reduce the number of injections needed. Topical hyaluronic acid also would help patients who are averse to needles or are just starting to get wrinkles and are looking for noninvasive therapy. This article reviews combinations of cosmeceuticals with cosmetic procedures that dermatologists may want to consider discussing with their cosmetic patients.

Evidence-based management of primary and localized Merkel cell carcinoma: a review.

BACKGROUND: Merkel cell carcinoma is a rare and often lethal cutaneous neuroendocrine malignancy with a tendency for early and frequent locoregional and distant metastasis and relapses. It is a tumor of the elderly and immunosuppressed, which most often appears on sun-exposed areas of the body. There is growing interest in characterization of the disease and the best approach to its management. Despite the lack of prospective randomized clinical trials, treatment is evolving. OBJECTIVE: To provide an updated review of the most current and relevant data concerning the surgical (± radiological) management of Merkel cell carcinoma, including the role of Mohs micrographic surgery. METHODS: Using relevant MeSH terms, we performed a review of the literature on the above subjects from 1981 to 2011. RESULTS AND CONCLUSION: For primary tumors without evidence of organ metastases, surgical excision should be the primary therapy. Owing to the high rate of local metastases, a safety margin of at least 2 cm should be considered. In situations where small, localized tumors and/or special locations necessitate a smaller safety margin, compensation by complete histological examination of the excision margins and perhaps adjuvant radiation therapy should be undertaken. The literature states that benefits of Mohs micrographic surgery (over wide local excision) include tissue conservation and identification of tumors that may require extremely wide excision margins. The majority of data to date supports the use of Mohs surgery in the treatment of Merkel cell carcinoma.

Borrelia burgdorferi Infections in the United States.

It is becoming increasingly evident that the clinical presentation of infection with Borrelia burgdorferi varies greatly between different parts of the world. A growing number of European and Asian isolates of Lyme borreliae, differing from the American strain of Borrelia burgdorferi, have been identified in several different disorders. In light of the increasing number of reports describing an association between various cutaneous disorders and infection with Borrelia burgdorferi and the controversy that still remains over where Borrelia burgdorferi is truly pathogenic in these diseases, this review of the literature assesses the significance of these reports in substantiating these hypotheses, as such associations are important both diagnostically and therapeutically.

Posterior fossa syndrome after surgical removal of a pineal gland tumor.

Posterior fossa syndrome, characterized by oromotor or oculomotor apraxia, emotional lability, and mutism, occurs in some children after infratentorial tumor resection, and is thought to involve injury to the dentatothalamocortical tract. Previous cases of posterior fossa syndrome involved pediatric patients with cerebellar and other posterior fossa tumors. To heighten awareness that posterior fossa syndrome can occur after resections of tumors in other neuroanatomic locations, we present a 16-year-old boy who developed this syndrome after surgical removal of a supratentorial pinealoma, and we include a discussion of his self-reported signs.