Lymphomatoid Papulosis With T-cell Receptor-Gamma Delta Expression: A Clinicopathologic Case-series of 26 Patients of an Underrecognized Immunophenotypic Variant of Lymphomatoid Papulosis.

Lymphomatoid papulosis (LyP) has several histopathologic presentations. LyP featuring gamma-delta (γδ) T-cell receptor expression may masquerade as and may be misdiagnosed as aggressive cutaneous T-cell lymphoma, particularly primary cutaneous γδ T-cell lymphoma (PCGDTL) or γδ mycosis fungoides. We performed a clinicopathologic analysis of the largest series of LyP featuring γδ T-cell expression. We identified 26 patients with a diagnosis of LyP with γδ T cells from our institutions, as well as through a comprehensive review of the literature, and characterized these cases. Most cases were treated with topical steroids or not treated at all. The majority of cases showed a CD4 - CD8 + phenotype and featured at least one cytotoxic marker. Histopathologic features included an intraepidermal or dermal infiltrate with large cells and frequent angiotropism. One case was initially misdiagnosed as PCGDTL, requiring further therapy. Our case series, the largest international cohort of γδ T cell predominant LyP cases, confirms marked clinicopathologic heterogeneity that may contribute to misdiagnosis, reasserting the need to identify classic clinical features, CD30 + T-cell components, and markers of cytotoxicity when dealing with this differential diagnosis. A limitation of this study includes somewhat limited follow-up, histologic, and immunophenotypic information for some cases.

Impact of, Factors for the Success of, and Concerns Regarding Transplant Patients' Skin Cancer Campaigns: Observational Study.

BACKGROUND: Due to rising health care costs, patients have sought alternative ways of addressing medical expenses. In particular, transplant patients have complex and expensive medical needs-including skin cancer surveillance-that may not be fully covered by insurance. One such method of financing medical costs is by crowdsourcing through web-based platforms, most notably GoFundMe. OBJECTIVE: Previous work identified factors associated with GoFundMe campaigns' fundraising success for dermatologic diseases. We sought to characterize these factors in transplant recipients' campaigns for funds raised for covering skin cancer-related costs. These factors include demographics, campaign traits, and subjective themes. METHODS: From January to April 2022, we analyzed GoFundMe campaigns using the following search terms chosen on the basis of author consensus: "transplant skin cancer," "transplant basal cell," "transplant squamous," "transplant melanoma," and "dermatologist transplant." Demographic data were coded from campaign text or subjectively coded based on author consensus. Campaigns were read completely by 2 independent coders and associated with up to 3 different themes. Linear regression was performed to examine the qualities associated with success, which was defined as funds raised when controlling for campaign goals. Logistic regression was used to examine qualities associated with extremely successful campaigns, defined as those raising funds over 1.5 times the IQR. RESULTS: Across 82 campaigns, we identified several factors that were associated with fundraiser success. Patients who experienced complications during infectious disease treatment, those who received a pancreas transplant, or those who died from their disease raised significantly more money. Patients older than 61 years raised significantly less money. Extremely successful campaigns (>US $20,177) were associated with campaigners who emphasized a disability from their disease, those who were reluctant to ask for help, or those who died due to their disease. CONCLUSIONS: Demographic and thematic factors are associated with transplant patients' skin cancer-related fundraising success, favoring those who are younger, in more extreme situations, and appear reluctant to ask for help; these findings are consistent with those of previous studies. Additionally, transplant patients have complex and expensive dermatologic needs that may not be fully covered by insurance, as reflected in their GoFundMe campaigns. The most commonly mentioned reasons for fundraising included living expenses or loss of income, inadequate or no insurance, and end-of-life costs. Our findings may inform transplant patients how to maximize the success of their campaigns and highlight gaps in health care coverage for skin cancer-related costs. Limitations include the possibility for misclassification due to the data abstraction process and limiting data collection to fundraisers available on GoFundMe while excluding those on other websites. Further research should investigate the ethical implications of crowdfunding, financial needs of this patient population, and potential ways to improve access to routine skin cancer surveillance among patients receiving transplants.

Thematic and Demographic Analysis of Crowdsourcing Practices for Plastic Surgery.

BACKGROUND: In this study, we investigate the characterization of medical crowdsourcing on GoFundMe for plastic surgery procedures, with overall funds raised being the primary end point. HYPOTHESIS: Certain demographic factors such as sex and race mentioned in campaign narratives are associated with the effectiveness of medical crowdfunding campaigns. METHODS: Search terms were used to aggregate fundraising campaigns for plastic surgery medical procedures on GoFundMe. These studies were then stratified by demographics based on campaign text or author consensus, and were further subdivided into categories based on procedure type. RESULTS: Men were found to have higher median shares than women-raising an average of $609 more than female counterparts ( P < 0.05). Fundraising for themes such as lack of insurance, travel costs, lifesaving treatment, and end-of-life expenses were more successful than the theme of psychosocial effects of disease or social impairment. In addition, those that included a smiling picture of the recipient and those created by a friend/relative raised more funds. Although no significant difference was found in fundraising between demographics based on race, a majority (72.8%) of campaigners were White. Across ~2000 plastic surgery campaigns, a total of $10,186,687 were raised from these data. CONCLUSIONS: We identified both modifiable and nonmodifiable factors that influence success. These successful campaigns can serve as a learning opportunity for many who have been marginalized by the medical and pharmaceutical industry, and they demonstrate a promising area for demographic studies.

Malignant chondroid syringoma: A systematic review.

Malignant Chondroid Syringomas (MCS) are very rare malignant tumours arising from cutaneous sweat glands, with only 51 reported cases in the literature. These tumours can metastasize and cause death if not treated adequately. While there are histological criteria to diagnose MCS tumours, there are no established criterion to determine which tumours are more or less likely to metastasize. A systematic review was performed to establish if any features of the primary MCS tumour are associated with risk of metastasis or patient mortality, as well as the efficacy of common treatment options. The literature search was performed using the Ovid Medline and Web of Science databases from inception through March 2020. This yielded 47 case reports corresponding to 51 unique patients. Statistical analysis of the collected data revealed none of the commonly accepted malignant histopathologic findings (including nuclear atypia and/or pleomorphism, mitotic figures, an infiltrative growth pattern, presence of satellite nodules, necrosis, and vascular and/or perineural invasion) of the primary tumour to be significantly more associated with metastatic risk or death. However, gross characteristics of the tumour, including size (greater than 5 cm) and truncal location of the primary lesion, were found to be associated with a higher risk of metastasis. The most effective treatment modality was wide local excision. Overall, primary MCS tumours, especially those greater than 5 cm or located on the trunk, should be treated with a wide local excision and followed closely to confirm no lesion recurrence or distant metastasis.

The Ratings Game: Demographic and Practice Factors Affecting Yelp Ratings of Plastic Surgeons.

BACKGROUND: Review platforms such as Yelp are increasingly used by patients establishing care and may contain substantial information regarding patient preferences and potential biases. The authors' aims were to (1) analyze patient satisfaction through identifying factors associated with positive and negative patient reviews for plastic surgery providers across the United States, and (2) investigate the association between overall rating and different physician and practice factors based on gender and race. METHODS: Reviews of plastic surgery provider practices from cities across seven different regions within the United States were obtained from Yelp. Quantitative and qualitative analyses were performed. Chi-square tests were used to determine whether race or sex was associated with overall rating (of five stars) and qualitative themes. RESULTS: A total of 5210 reviews met inclusion criteria; 80.3% received a five-star rating and 13.5% received a one-star rating. Positive Yelp reviews and higher ratings were associated with positive comments regarding surgical and injectable outcomes, physical examination, communication, competency/knowledge base, temperament, scheduling, and staff interactions. When the following factors were mentioned negatively, the practice was more likely to receive a lower rating: temperament, communication, cost consciousness, surgical and injectable outcomes, physical examination, billing/insurance, scheduling, interactions with staff, and wait times. No association was identified in terms of overall physician rating based on sex or race; however, there were differences noted in distribution of positive and negative themes. CONCLUSIONS: Patient reviews on Yelp indicate that several physician and practice factors influence patient satisfaction. The themes reported in this study may be used by plastic surgery providers to identify areas for practice improvement to enhance the overall patient experience.

Primary Cutaneous Anaplastic Large-Cell Lymphoma With Aberrant CD20 Expression: Case Report and Review of the Literature.

ABSTRACT: Cutaneous CD20 + T-cell lymphomas are exceedingly rare. Differentiating cases of T-cell lymphoma with aberrant expression of the B-cell marker CD20 from B-cell lymphoma may be associated with misdiagnosis or delays in diagnosis. We report, to the authors' knowledge, the first case of CD20 + primary cutaneous anaplastic large-cell lymphoma and review the literature to characterize published cases of CD20 + cutaneous T-cell lymphoma (n = 40). There is no accepted explanation for this phenomenon; however, it is suspected that these cases may be due to neoplastic transformation of CD20 + T cells or that CD20 may represent a T-cell activation marker. Expression of CD20 may have clinical significance in prognostication and consideration of treatment options with anti-CD20 therapies such as rituximab.