Assessment of Functionality in Elderly Patients When Determining Appropriate Treatment for Nonmelanoma Skin Cancers.

BACKGROUND: The treatment of nonmelanoma skin cancer (NMSC) in the elderly population is a source of significant debate. Mohs micrographic surgery (MMS) is a highly effective treatment option yet not every patient with a cutaneous malignancy that meets appropriate use criteria (AUC) should be treated with surgery. OBJECTIVE: The purpose of this study was to use the Karnofsky Performance Status (KPS) scale to categorize the functional status of patients aged 75 years and older who required treatment of NMSC. The authors wanted to see whether functionality played a role on the treatment selection. METHODS: Patients aged 75 years and older presenting for biopsy of a suspected NMSC that met AUC for MMS were included in the study. Trained medical assistants used the KPS scale to assess patient functionality. Treatment modality was recorded once the biopsy confirmed the NMSC. RESULTS: A cohort of 203 subjects met inclusion criteria for the study. There was a statistically significant difference in utilization of surgical treatments between high and low functionality patients (p = .03). CONCLUSION: Dermatologists consider patient functionality when selecting a treatment for NMSC and use less invasive modalities for patients with poor functional status, even when the tumor meets AUC.

Discoid lupus erythematosus following herpes zoster.

The isomorphic response is the appearance of new lesions from a preexisting skin condition at a site of trauma. Discoid lupus erythematosus (DLE) may develop on traumatized skin and also may arise at sites of a prior cutaneous eruption. We report the case of a 20-year-old woman with a history of systemic lupus erythematosus (SLE) and DLE who developed a painful, multidermatomal, vesicular rash on the left breast and back consistent with herpes zoster (HZ) during treatment with systemic immunosuppression. Four months after the HZ resolved, the patient developed new-onset DLE lesions within the prior HZ-affected dermatomes. Our case is one of few reports of an isomorphic response in an immunosuppressed young woman with a history of SLE and DLE. When HZ presents in this patient population, close monitoring of the HZ-affected sites for any evidence of DLE is recommended. Topical corticosteroids should be applied to the involved areas at the earliest appearance of such lesions to further prevent potentially scarring DLE lesions.

Melanoma and basal cell carcinoma in the hereditary leiomyomatosis and renal cell cancer syndrome. An expansion of the oncologic spectrum.

BACKGROUND: Hereditary leiomyomatosis and renal cell cancer syndrome (HLRCC) is an autosomal dominant syndrome due to mutation in fumarate hydratase. Patients with HLRCC frequently develop cutaneous and uterine leiomyomata and are at risk for renal cell carcinoma. Rarely, other malignancies have been reported. MAIN OBSERVATIONS: We report the development of basal cell carcinoma and melanoma in two siblings with genetically-confirmed HLRCC. CONCLUSIONS: It is unclear whether the development of melanoma and basal cell carcinoma in our patients is due directly to their mutations in the gene encoding fumarate hydratase, or genetic susceptibility at another unrelated locus, or whether these are incidental lesions. However this observation has implications for careful and routine skin surveillance in patients with HLRCC for lesions other than cutaneous leiomyomata.

Seeing double: annular diaper rash in twins.

We report a case of dichorionic, diamniotic twins who developed similar erythematous, annular, erosive plaques in the inguinal folds in the first few weeks of life that were refractory to topical antifungals and oral antibiotics. The twins were found to have high transaminase levels, antinuclear antibody positivity, and anti-SSS/Ro) and anti-SSB/La autoantibodies. The rash resolved without scarring by 7 months of age with the use of low-potency topical corticosteroids. We suggest that physicians consider neonatal lupus erythematosus in neonates with atypical eruptions occurring in sun-protected skin.

Fulminans in dermatology: a call to action: a recommendation for consideration of the term scleredema fulminans.

The term fulminans is used infrequently in dermatology, being reserved for those cases of rapid onset with potentially severe sequelae or those that are life-threatening, thereby warranting urgent intervention. In this commentary, the authors propose that the term scleredema fulminans be utilized in severe, progressive cases of scleredema adultorum of Buschke presenting with rapid onset.

Regulated Expression of Chromobox Homolog 5 Revealed in Tumors of Apc(Min) (/+) ROSA11 Gene Trap Mice.

The gene-trap lacZ reporter insertion, ROSA11, in the Cbx5 mouse gene illuminates the regulatory complexity of this locus in Apc(Min) (/+) mice. The insertion site of the ß-Geo gene-trap element lies in the 24-kb intron proximal to the coding region of Cbx5. Transcript analysis indicates that two promoters for Cbx5 flank this insertion site. Heterozygotes for the insertion express lacZ widely in fetal tissues but show limited expression in adult tissues. In the intestine, strong expression is limited to proliferative zones of crypts and tumors. Homozygotes for ROSA11, found at a lower than Mendelian frequency, express reduced levels of the coding region transcript in normal tissues, using a downstream promoter. Analysis via real-time polymerase chain reaction indicates that the upstream promoter is the dominant promoter in normal epithelium and tumors. Bioinformatic analysis of the Cbx5 locus indicates that WNT and its target transcription factor MYC can establish a feedback loop that may play a role in regulating the self-renewal of the normal intestinal epithelium and its tumors.

Persistent melanocytic nevi: a review and analysis of 205 cases.

BACKGROUND: Melanocytic nevi can recur or persist if not completely excised and are capable of mimicking malignant melanoma, both clinically and histologically. OBJECTIVE: To characterize the impact of anatomic site, biopsy method, size, margin involvement and type of original melanocytic nevus on recurrence/persistence of melanocytic nevi. Secondarily, we sought to determine if the original type of melanocytic nevus could be determined solely from microscopic examination of the recurrent/persistent nevus. METHODS: One hundred and eighty-five patients with 205 persistent nevi were identified. Of these, 108 cases had original biopsy specimens available for review. Location, original biopsy size, biopsy method, margins and interval to recurrence were recorded for each. A group of 232 non-persistent nevi was established as a control population. RESULTS: There was a female predominance in persistent nevi with the back being the most common site for persistence. Dysplastic melanocytic nevi were the most likely to persist. Accurate determination of the original type of melanocytic nevus from microscopic examination of the persistent nevus was possible in only 67% of the cases. CONCLUSION: Clinicians should take larger and deeper biopsies of clinically dysplastic and conventional melanocytic nevi on the back to prevent recurrences. Grading atypia of the persistent melanocytic nevi is unreliable.