A rare case of primary cutaneous malignant perivascular epithelioid cell tumor and review of the literature.

A 77-year-old female presented with a 6-month history of a 2-cm pink exophytic tumor on the right anterior shin, which had grown rapidly and began to bleed over the last 4 weeks. A shave biopsy showed a dermal proliferation of epithelioid spindled cells, arranged in nests and trabeculae associated with thin-walled capillary vessels. The cells showed pleomorphic nuclei with vacuolated nuclear chromatin and occasional prominent nucleoli. Mitotic figures (7/10 high-power fields [HPFs]), including atypical forms, were present in the specimen. Immunohistochemical staining was negative for SOX10 and stained positive for MiTF. The histopathologic findings were consistent with a malignant perivascular epithelioid cell tumor (PEComa). A malignant PEComa is a rare entity of mesenchymal-derived cells with both melanocytic and myocytic differentiation. A PEComa is considered to be malignant by fulfilling two of the following criteria: size greater than 5 cm, vascular invasion, necrosis, mitotic figures greater than 1 per 50 HPF, infiltrative growth pattern, high nuclear grade, and hypercellularity. PEComas show immunohistochemical positivity to myocytic markers such as SMA, pan-muscle actin, muscle myosin, calponin, and h-caldesmon as well as melanocytic markers such as HMB-45, Melan-A, tyrosinase, and MiTF.

Persistent venous leg ulcers complicated by linear morphea: a case report.

Soft tissue ulceration resulting from chronic venous insufficiency is a common condition that requires standardised long-term therapy, which has been thoroughly established. We report a patient with a five-year history of persistent venous stasis ulcers despite treatment consistent with traditional wound care. Resolution of the ulcers began only upon deviation from conventional therapy. This report considers non-standard treatments in patients with venous ulcers that do not progress.

Considerations for Timing of Defect Reconstruction in Cutaneous Melanoma of the Head and Neck.

The objective of this study is to identify the incidence and characteristics of cases with positive margins on wide local excision for cutaneous melanoma of the head and neck (CMHN) and therefore provide a potential basis for selectively delaying reconstruction pending final histological clearance of melanoma. A systematic review of English language articles was performed on studies retrieved from PubMed and Web of Science. Original investigations published between July 1999 and June 2018 reporting on margin status of CMHN wide local excision specimens were included in the review. The incidence of positive margins after definitive resection for cutaneous melanoma in the literature ranges from 6 to 20.9%. The incidence is higher in cases of advanced patient age, diagnosis by shave biopsy, lentigo maligna melanoma subtype, desmoplastic subtype, tumor thickness, and ulceration. Delayed reconstruction remains the most oncologically sound decision, allowing for interpretation of margin status on paraffin-embedded tissue sections. However, resection and the resultant defect closure in a single stage is more expedient and potentially a more efficient use of resources. The risk-benefit ratio of immediate versus delayed reconstruction must be considered for each case. The incidence of positive margins is higher in cases of advanced patient age, diagnosis by shave biopsy, lentigo maligna melanoma subtype, desmoplastic subtype, increasing tumor thickness, and the presence of ulceration; delayed reconstruction should be strongly considered in these cases.

Patterns of recurrence and retreatment outcomes among clinical stage I and II head and neck melanoma patients.

BACKGROUND: The objective of this study was to determine survival outcomes in patients who underwent retreatment of recurrent cases of cutaneous melanoma of the head and neck (CMHN). METHODS: Retrospective review of all patients who were treated for primary clinical stage I or II CMHN between January 1, 2000 and December 31, 2015. RESULTS: Twenty percent (33/168) of the patients developed a recurrence. Sixty-six percent (4/6) of patients who developed local recurrence first and 50% (3/6) of patients who developed regional recurrence first were alive without evidence (NED) of disease at last follow-up, while 0% (0/21) of patients who developed distant or simultaneous recurrences first were NED at last follow-up. Among the 7 patients who were NED, the mean time from recurrence to last follow-up was 735 days. CONCLUSIONS: Of patients with isolated local or regional recurrences, 58% (7/12) obtained durable curative treatment for recurrent melanoma.