Paracicatricial melanocytes as a sign of melanoma.

Intradermal melanocytes in the setting of melanoma represent a diagnostic challenge to dermatopathologists as their presence may represent superficially invasive melanoma vs benign nevus cells or reactive dermal melanocytes. Previous dermatologic literature suggests that the absence of cytologic atypia in intradermal melanocytes and their presence in nonmelanocytic neoplasms lends to their characterization as reactive, benign, melanocytic proliferation. A 67-year-old female presented for evaluation of a 10-mm irregularly pigmented dark brown macule on the left cheek. Initial shave biopsy showed transected malignant melanoma measuring at least 0.6 mm in thickness. Multiple reexcision specimens demonstrated residual melanoma with banal appearing intradermal epithelioid melanocytes within and surrounding the scar. The melanocytes tracked into the skin graft, which had previously been free from involvement. Positron emission tomography-computed tomography (PET CT) and lymph node biopsies did not show evidence of metastatic melanoma. Ten months after her diagnosis and following five surgical excisions, the patient was diagnosed with metastatic melanoma to the brain and succumbed to intracranial hemorrhage. We present a case in which paracicatricial melanoma may simulate benign paracicatricial melanocytic hyperplasia. These findings have significant therapeutic and prognostic implications for the practicing dermatologist and dermatopathologist.

Clear Cell Differentiation in Eccrine Porocarcinoma as a High-Risk Feature: Epidemiologic and Pathologic Features of Eccrine Porocarcinoma in a Single-Center Case Series.

ABSTRACT: Eccrine porocarcinoma (EPC) is a rare sweat gland malignancy. Recognition of histologic features is challenging, and specific pathologic features correlate with risk of poor outcome. This single-center retrospective review and case series of 58 EPC cases from 2000 to 2016 elucidates epidemiologic and pathologic characteristics of EPC. Pathology slides from 52 cases were analyzed by a dermatopathologist for standardized variable characteristics, including previously determined high-risk features (HRF) associated with poor prognosis. The incidence of EPC increased over the study period with 3 times more cases diagnosed in the last 4 years than in the first 4 years. Most cases were in the elderly males (mean age 75 years), and 50% were located in the head and neck region. Although 38% of tumors exhibited one histologic HRF, only 10% exhibited more than one. Of the HRF, a greater tumor depth was associated with both increased age (P = 0.04) and clear cell differentiation (P = 0.02). This study elucidates epidemiologic and pathologic features of EPC and highlights how age and clear cell differentiation can be associated with greater tumor depth, although further research is needed to determine whether clear cell differentiation is associated with poor clinical outcome.

Trends in matching into Mohs Micrographic Surgery fellowship among underrepresented minority applicants from 2016 to 2020: a retrospective review study.

Disparities in racial diversity in the field of dermatology continue to persist given that dermatology has the second lowest percentage of underrepresented minorities (URM), only second to orthopedic surgery. This study aims to investigate any trends in racial representation of Mohs Micrographic Surgery (MMS) fellowship applicants over a five-year period from 2016 to 2020. Dermatology residency applicant race data were extracted from the San Francisco Match for application seasons 2016-2020 for a retrospective review study. There was an overall increase in the number of MMS fellowship applicants during the five-year study period. Prior to 2018 (midpoint of study), 6.6% of matched applicants and 10.9% of unmatched applicants identified as URMs, compared to 8.1% of matched applicants and 10.1% of unmatched applicants after 2018, but this increase was not statistically significant (p = 0.62). There is hope that Mohs Micrographic Surgery fellowship applicants are becoming more racially diverse with improved representation of underrepresented minorities.

Trends in racial diversity of dermatology residency applicants from 2016 to 2020: a retrospective review study.

Disparities in racial diversity in the field of dermatology continue to persist given that dermatology has the second lowest percentage of underrepresented minorities (URM), only second to orthopedic surgery. This study aims to investigate any trends in racial representation of dermatology residency applicants over a 5-year period from 2016 to 2020. Dermatology residency applicant race data were extracted from the Electronic Residency Application Service (ERAS) of the Association of American Medical Colleges (AAMC) for application seasons 2016-2020 for a retrospective review study. There was an overall increase in the number of dermatology residency applicants during the 5-year study period. Prior to 2018 (midpoint of the study), 14.1% of applicants identified as URM compared to 16.2% after 2018, although this difference was not statistically significant (p = 0.25). Our findings suggest that in the study period analyzed, racial representation remained relatively similar, with a non-statistically significant increase in URM applicants. Outlining the current trends in dermatology residency applicants may be helpful in identifying factors affecting the disparity in racial representation within the field. There is hope that dermatology residency applicants are becoming more racially diverse with improved representation of URMs.

Medical Management of Hidradenitis Suppurativa with Non-Biologic Therapy: What's New?

Hidradenitis suppurativa (HS) is a severe chronic relapsing inflammatory disorder of the hair follicle unit that can cause painful abscesses, nodules, tunnels, and tracts in intertriginous parts of the body. The disease can often result in disfigurement and adversely impact patient quality of life. The management of HS has expanded significantly over the past decade to include multiple modalities, including topical therapies, systemic therapies (non-biologics and biologics), surgical therapies, lifestyle changes, and management of comorbidities. Management can often be clinically challenging and may involve the combination of medical and surgical approaches for optimal results. The purpose of this review is to present an update on non-biologic and non-interventional modalities published in 2019-2021 in the clinical management of HS. With emerging therapies, ongoing clinical trials, and heightened awareness about HS, there is hope that new treatment options will revolutionize the management of patients suffering from HS.

Candida Infection Associated with Anti-IL-17 Medication: A Systematic Analysis and Review of the Literature.

Anti-interleukin (IL)-17 agents have shown excellent therapeutic efficacy in patients with psoriasis and are expected to be expanded to other chronic inflammatory diseases. However, patients receiving anti-IL-17 agents are at an increased risk of developing Candida infection, with some agents reported to increase the incidence in a dose-dependent manner. Interleukin-17 is secreted by the Th17 subset of CD4+ lymphocytes, CD8+ T cells, and innate cells, including natural killer T cells, lymphoid tissue inducer cells, innate lymphoid cells, and γδ-T cells, and plays an important role in antifungal defense. Genetic defects in the IL-17-signaling pathway in both humans and animal models render susceptibility to candidiasis caused by Candida albicans. The purpose of this narrative review is to evaluate the literature on the role of IL-17 in protection against candidiasis, the prevalence of candidiasis in anti-IL-17 agent use, and to offer clinical recommendations on the diagnosis and management of anti-IL-17 medication-associated candidiasis.

Odds of Merkel cell carcinoma metastases associated with primary anatomic site and laterality.

Merkel cell carcinoma (MCC) is a neuroendocrine skin malignancy associated with ultraviolet radiation exposure and the Merkel cell polyomavirus. This study aims to examine associations between primary tumor anatomic site, laterality, and metastases in MCC in the Surveillance Epidemiology and End Results (SEER) database and an academic center MCC database in Rhode Island (RI). A retrospective chart review of 92 MCC cases from RI Hospital and 2845 subjects from the SEER registry was analyzed. Logistic regressions in each cohort were performed to calculate odds ratios (OR), adjusting for sex, age at diagnosis, race, and marital status. The majority of tumors were left-sided in the SEER cohort (53.0%) and RI cohort (56.5%), and located on the head and neck region in the RI cohort (60.9%) and the trunk and extremities in the SEER cohort (70.8%). Left-sided tumors compared to right-sided tumors were marginally associated with increased odds of metastasis in the SEER cohort (OR 1.05, 95% CI 0.87, 1.27); however, decreased risk of MCC was found in the RI cohort (OR 0.33, 95% CI 0.13, 0.80). Tumors located on the trunk and extremities were marginally associated with decreased odds of metastasis compared to head and neck tumors in both databases (SEER: OR 0.88, 95% CI 0.72, 1.08 and RI cohort: OR 0.62, 95% CI 0.25, 1.50). Left-sided tumors located on head and neck showed a suggestive evidence of increased odds of MCC among females in the SEER data (OR 1.77, 95% CI 0.98, 3.23). Our study potentially has important implications for clinical tumor diagnosis and prognostication as well as improved understanding about the epidemiology of MCC.

Demographic features and changing incidence and presentation of Merkel cell carcinoma in a retrospective single-center case series.

Merkel cell carcinoma (MCC) is an uncommon aggressive cutaneous neuroendocrine tumor with high mortality. The purpose of this study is to describe the clinical correlates of MCC and identify changing trends over time using a retrospective chart review of 113 cases in a single tertiary center pathology database from 1997 to 2015. MCC occurred mostly in the elderly (median age 77 years), more often in males (n = 60, 53%), was most commonly located on the head and neck region (n = 63, 56%), and most commonly presented on the left side of the body (n = 59, 52%). Overall, there was an increase in MCC diagnoses per year from 1997 to 2015, with 2.3 times more cases diagnosed in the last 3 years of the study period than in the first 3 years. Furthermore, cases diagnosed after 2008 were more likely to occur in younger patients, less than or equal to 77 years of age (OR 2.32, 95% CI 1.08, 4.97, p = 0.04). The median age of diagnosis among females was 76 years and among males was 74 years. There was no change in the overall age of diagnosis among men and a decrease in age of diagnosis among females during the study. There was an overall increase in the MCC cases diagnosed among women, and a slight increase in the proportion of females affected by MCC throughout the course of the study. This retrospective case series elucidates MCC epidemiologic characteristics and describes how incidence, sex, and age at diagnosis have changed over the course of the study.

Ischemia-induced Neuronal Cell Death Is Mediated by Chemokine Receptor CX3CR1.

The chemokine fractalkine (CX3CL1) and its receptor CX3CR1 play a fundamental role in the pathophysiology of stroke. Previous studies have focused on a paracrine interaction between neurons that produce fractalkine and microglia that express CX3CR1 receptors in the central nervous system. Recent findings have demonstrated the functional expression of CX3CR1 receptors by hippocampal neurons, suggesting their involvement in neuroprotective and neurodegenerative actions. To elucidate the roles of neuronal CX3CR1 in neurodegeneration induced by ischemic stroke, a mouse model of permanent middle cerebral artery occlusion (pMCAO) was employed. In the pMCAO mice, increased CX3CR1 levels, apoptosis-associated morphological changes, and Caspase 3-positive neuronal cells were observed in the striatum and in the hippocampus 24 hours after occlusion. Upregulation of CX3CR1 in ischemic neurons is associated with neuronal apoptotic cell death. In contrast, ischemia-induced apoptotic neuronal cell death was decreased in CX3CR1 deficient mice. Cultured primary hippocampal neurons obtained from CX3CR1 deficient mice were more resistant to glutamate-induced excitotoxicity by blocking calcium influx than those from wild-type mice. For the first time, we reported that neuronal CXCR1 mediates neuronal apoptotic cell death in ischemia. Our results suggest that modulating CXCR1 activity offers a novel therapeutic strategy for stroke.

Readability of Invasive Procedure Consent Forms.

BACKGROUND: Informed consent is a pillar of ethical medicine which requires patients to fully comprehend relevant issues including the risks, benefits, and alternatives of an intervention. Given the average reading skill of US adults is at the 8th grade level, the American Medical Association (AMA) and the National Institutes of Health (NIH) recommend patient information materials should not exceed a 6th grade reading level. We hypothesized that text provided in invasive procedure consent forms would exceed recommended readability guidelines for medical information. MATERIALS AND METHODS: To test this hypothesis, we gathered procedure consent forms from all surgical inpatient hospitals in the state of Rhode Island. For each consent form, readability analysis was measured with the following measures: Flesch Reading Ease Formula, Flesch-Kincaid Grade Level, Fog Scale, SMOG Index, Coleman-Liau Index, Automated Readability Index, and Linsear Write Formula. These readability scores were used to calculate a composite Text Readability Consensus Grade Level. RESULTS: Invasive procedure consent forms were found to be written at an average of 15th grade level (i.e., third year of college), which is significantly higher than the average US adult reading level of 8th grade (p < 0.0001) and the AMA/NIH recommended readability guidelines for patient materials of 6th grade (p < 0.0001). CONCLUSION: Invasive procedure consent forms have readability levels which makes comprehension difficult or impossible for many patients. Efforts to improve the readability of procedural consent forms should improve patient understanding regarding their healthcare decisions.

Readability of patient education materials on the american association for surgery of trauma website.

BACKGROUND: Because the quality of information on the Internet is of dubious worth, many patients seek out reliable expert sources. As per the American Medical Association (AMA) and the National Institutes of Health (NIH) recommendations, readability of patient education materials should not exceed a sixth-grade reading level. The average reading skill of U.S. adults is at the eighth-grade level. OBJECTIVES: This study evaluates whether a recognized source of expert content, the American Association for Surgery of Trauma (AAST) website's patient education materials, recommended readability guidelines for medical information. MATERIALS AND METHODS: Using the well-validated Flesch-Kincaid formula to analyze grade level readability, we evaluated the readability of all 16 of the publicly-accessible entries within the patient education section of the AAST website. RESULTS: Mean ± SD grade level readability was 10.9 ± 1.8 for all the articles. All but one of the articles had a readability score above the sixth-grade level. Readability of the articles exceeded the maximum recommended level by an average of 4.9 grade levels (95% confidence interval, 4.0-5.8; P < 0.0001). Readability of the articles exceeded the eighth-grade level by an average of 2.9 grade levels (95% confidence interval, 2.0-3.8; P < 0.0001). Only one of the articles had a readability score below the eighth-grade level. CONCLUSIONS: The AAST's online patient education materials may be of limited utility to many patients, as the readability of the information exceeds the average reading skill level of adults in the U.S. Lack of patient comprehension represents a discrepancy that is not in accordance with the goals of the AAST's objectives for its patient education efforts.