Surgical Outcomes Following Mohs Micrographic Surgery for Basal Cell Carcinoma on the Distal Third of the Nose.

Objective: The primary aim of this study is to determine a quantifiable difference in surgical outcomes between local skin flap, full thickness skin graft (FTSG), and secondary intention (SI) following Mohs micrographic surgery (MMS) for basal cell carcinoma (BCC) on the distal third of the nose. Methods: A retrospective chart review of 66 MMS defects on the distal third of the nose performed by a single surgeon between June 2019 to June 2020 was completed. Clinical images of MMS defects and postoperative scars at six months were recorded and measured by the Vancouver Scar Scale (VSS). Pearson Chi-square and Fisher's Exact tests were utilized to determine the relationship between the main predictor variables and VSS. Results: Of the 66 patients retained, 52 were deemed to have low VSS (77.61%), 11 had medium VSS (16.42%) and three had high VSS (4.48%). Of the 52 patients with low VSS, 40 underwent local flap (76.92%), nine underwent FTSG (17.31%), and three healed by SI (5.77%). Of the 11 patients with medium VSS, two underwent local flap (18.15%), nine underwent FTSG (81.82%), and zero healed by SI. Of the three patients with high VSS, zero underwent local flap or SI, while all three underwent FTSG (100%). Bivariate analysis demonstrated that repair type employed was associated with VSS at six months (p<0.0001) with patients treated with local skin flap having better outcomes. Conclusion: Our data illustrate that local skin flaps might result in a lower VSS at six months compared to FTSG or SI, therefore offering superior surgical outcomes in the treatment of BCC on the distal third of the nose.

Platelet-Rich Plasma: A Comprehensive Review of Emerging Applications in Medical and Aesthetic Dermatology.

Platelet-rich plasma (PRP) has been integrated into numerous treatment regimens for medical and aesthetic dermatology. While some of these approaches are well-established, many uses are underreported in the literature. We sought to identify and summarize the emerging dermatologic applications for PRP by conducting a comprehensive PubMed search of studies published between 2000 and 2020. These studies were reviewed to synthesize collection methods, treatment schedule, adverse effects, and the impact of therapy for new and emerging uses for PRP. In general, we identified positive treatment outcomes for skin rejuvenation, scar revision, alopecia, pigmentary disorders, lichen sclerosus, leprosy-induced peripheral neuropathy, plaque psoriasis, and nail disorders. Widely, therapy was well-tolerated and suitable for all reported phototypes. The variations in collection and application sequences make concrete recommendations difficult to discern, underscoring the need for a standardized approach to preparation and treatment methods. We hope this review serves as an outline for new and interesting uses for PRP and will help readers familiarize themselves with this exciting technology for comfortable integration into their practices.

An Atypical Presentation of Pityriasis Rosea Localized to the Extremities.

Pityriasis rosea (PR) is a benign, self-limiting, papulosquamous disorder characterized by the onset of a herald patch followed by an abrupt eruption of multiple salmon-colored papules and plaques on the trunk and proximal extremities. The individual lesions are often outlined by a collarette of scale and are distributed along the lines of cleavage. While many authors acknowledge an etiologic association with human herpesvirus 6 and human herpesvirus 7, thereby suggesting a viral exanthem, the exact cause remains unclear. While typically demonstrating a truncal predilection, this presentation may be absent in some patients who instead exhibit atypical features and distributions. Various clinical variants include papular, vesicular, purpuric, and eczematoid. The condition rarely manifests without truncal involvement and localized only to the distal extremities. We present a unique case report of a 65-year-old-male with biopsy-proven PR that was localized to his distal extremities with a clinical absence of truncal involvement.

Isolated Cutaneous Langerhans Cell Histiocytosis Presenting in an Adult Male.

Langerhans cell histiocytosis (LCH) is an infrequent clonal proliferative disorder of myeloid dendritic cells. It has a wide variety of cutaneous manifestations and retains the possibility of systemic implications. Because LCH is predominantly a disease of childhood, there are well-established clinical definitions, as well as guidelines regarding workup and treatment, in the context of pediatric disease. Here we present a case of isolated cutaneous LCH in an adult male, followed by a discussion of our diagnostic plan and treatment course. The patient exhibited a small, excoriated, yellow papule on his inferior forehead during a skin examination. The specimen underwent tangential shave biopsy; histopathologic evaluation with appropriate immunohistochemical staining confirmed a diagnosis of cutaneous LCH. After thorough investigation via serologic and imaging diagnostics, we confirmed isolated cutaneous disease. The patient underwent wide local excision (WLE) with no evidence of recurrence. It is crucial to appropriately screen all patients diagnosed with cutaneous LCH for internal organ involvement. The authors aim to highlight the need for further investigations to ultimately dictate standardized management and treatment for isolated cutaneous LCH in the adult population.

Cutaneous angiosarcoma of the leg.

Angiosarcomas are malignant neoplasms arising from endothelial cells. Cutaneous angiosarcoma is the most common form, typically occurring in the setting of chronic lymphedema or previous radiation. The head and neck are the most common locations for cutaneous angiosarcoma, with rare occurrence on the trunk and extremities. Herein, we present a case of angiosarcoma on the lower extremity in an elderly man. This 71-year-old man presented with a two-year history of red-yellow discoloration of the left lower leg with subsequent development of black nodules over the past several months prior to presentation. He denied any itching, bleeding, or ulceration. Past medical history included diabetes, hypertension, and non-melanoma skin cancer. Physical examination showed erythematous, violaceous, non-blanchable papules with yellow atrophic regions and overlying black crusted nodules and plaques. Biopsies were taken and the patient was diagnosed with angiosarcoma and referred to a tertiary care center for further evaluation.

Unusual case of pemphigus vulgaris mimicking localized pustular psoriasis of the hands and feet.

We report a case of a 70-year-old man with a history of chronic plaque psoriasis presenting with new-onset vesiculopustules of the hands and feet. Hematoxylin and eosin stain as well as direct and indirect immunofluorescence were all consistent with a diagnosis of pemphigus vulgaris. Unusual presentations of pemphigus vulgaris have been reported in the literature. Our case easily could have been clinically misdiagnosed as pustular psoriasis.

Oral pemphigus vulgaris after anthrax vaccine administration: association or coincidence?

Pemphigus vulgaris is an autoimmune blistering disorder of the skin and mucous membranes. Numerous medications, ultraviolet light, and radiation have all been implicated in the etiology of the disease. We present a patient with pemphigus vulgaris whose disease developed after administration of anthrax vaccine. The histologic and immunofluorescence findings were characteristic of pemphigus vulgaris. Adverse systemic events associated with the anthrax vaccine consist primarily of flu-like symptoms. Previous cases of pemphigus vulgaris associated with anthrax vaccine administration have not been reported. Considering the recent deliberate outbreaks of anthrax and continued threats of bioterrorism, the potential exists for widespread administration of the anthrax vaccine. Accordingly, continued observation and documentation of true adverse events is needed.