The effect of histopathologic analysis and tissue cultures on inpatient management of cellulitis: a randomized control trial.

BACKGROUND: In the absence of a gold-standard diagnostic modality for cellulitis, sterile inflammatory disorders may be misdiagnosed as cellulitis. OBJECTIVE: To determine the utility of skin biopsy and tissue culture for the diagnosis and management of patients admitted with a diagnosis of presumed cellulitis. DESIGN: Pilot single-blind parallel group randomized controlled clinical trial in 56 patients with a primary diagnosis of presumed cellulitis. In the intervention group only, skin biopsy and tissue culture results were made available to the primary care team to guide diagnosis and management. Length of hospital stay and antibiotic use were evaluated as outcome measures. RESULTS: Length of stay showed the greatest opportunity for further study as a primary outcome (intervention: 4, IQR (2-6) vs. control: 5 IQR (3-8) days; p = 0.124). LIMITATIONS: The COVID-19 pandemic placed limitations on participant enrollment and study duration; in addition, data was collected from a single medical center. CONCLUSION: This study demonstrates that length of stay and anti-pseudomonal antibiotic de-escalation are endpoints that may be influenced by biopsy and tissue culture results in presumed cellulitis patients; these outcomes warrant further study.

Keratoacanthoma and Cutaneous Squamous Cell Carcinoma With PD-1 and PD-L1 Inhibitor Use.

This cross-sectional study assesses risk of dermatological immune-related adverse events associated with immunotherapy for cancer.

Mohs micrographic surgery of penile squamous cell carcinoma in situ with urethral extension.

Squamous cell carcinoma in situ (SCCIS) of the glans penis with urethral involvement is a rare entity that is well-suited for Mohs micrographic surgery (MMS) given its high risk of local recurrence. However, MMS in this area is technically challenging, and surgery at this site often relies on the use of meatotomy for improved tumor visualization. We describe a less invasive approach to harvesting Mohs layers of the glans penis and distal urethra that obviates the need for meatotomy. For SCCIS tumors limited to the distal urethra, this is a straightforward technique that minimizes morbidity while still benefitting from the complete margin assessment and high cure rates associated with MMS.

Treatment and survival outcomes of ceruminous carcinomas of the external auditory canal: a SEER database analysis and literature review.

Ceruminous carcinomas of the external auditory canal (EAC), encompassing adenoid cystic carcinoma (ACC), ceruminous adenocarcinoma (CA), and mucoepidermoid carcinoma (MEC), are extremely rare with little known regarding the influence of demographics, tumor characteristics, and treatment on survival. This study aimed to summarize existent data and describe prognostic factors affecting survival in ceruminous carcinoma. Cases of ceruminous carcinoma of the EAC in the Surveillance, Epidemiology, and End Results (SEER) database were analyzed to provide demographic, cancer-related, and treatment data and assess their influence on disease-specific and overall survival. A literature review was also performed. No significant difference in overall survival (OS) existed for localized versus regional disease, tumor type, or use of radiation therapy. In those with ACC, distant disease had a lower OS compared to regional disease. On review of the literature, local recurrence was a common finding with a low risk for nodal metastasis in ACC and CA. In conclusion, local recurrence was common despite aggressive surgical intervention (± radiation therapy); overall survival was unaffected by radiation therapy, tumor type, or local versus regional disease; and more cases of MEC are needed for analysis.

Prognostic factors, treatment, and survival in cutaneous pleomorphic sarcoma.

BACKGROUND: Limited information exists on the influence of demographics, tumor characteristics, and treatment on survival in cutaneous pleomorphic sarcoma (CPS). OBJECTIVE: To describe incidence rates and prognostic factors affecting survival in CPS. METHODS: National Cancer Institute's Surveillance, Epidemiology, and End Results data (1972-2013) was analyzed for 2423 patients with CPS diagnoses. RESULTS: The age-adjusted incidence rate was 0.152 cases/100,000 person-years and was 4.5-fold higher in male than female patients. Male sex, white race, and increasing age >40 years were significantly associated with decreased overall survival. Head and neck tumors, tumors >15 mm, and tumors with grade III or IV histology were associated with significantly decreased survival. Surgical excision had a survival benefit compared with no treatment. Radiation therapy did not provide a survival benefit. Patients with localized disease had the greatest survival followed by regional and distant disease. LIMITATIONS: Surveillance, Epidemiology, and End Results data might not be reflective of all CPS patients. Recurrences, restaging, or other nonmortality events over time were not tracked. CONCLUSION: Tumor size, grade, sex, age at diagnosis, and race appear to influence survival as prognostic factors in CPS. Surgical tumor extirpation provides a survival benefit over no treatment whereas primary or adjuvant radiation does not provide a survival benefit.

Prognostic Factors, Treatment, and Survival in Primary Cutaneous Mucinous Carcinoma: A SEER Database Analysis.

BACKGROUND: Limited information exists on the demographics, tumor characteristics, and treatment in primary cutaneous mucinous carcinoma (PCMC). OBJECTIVE: The authors sought to describe prognostic factors, incidence rates, and the subsequent primary malignancy (SPM) risk in patients with PCMC. METHODS: Primary cutaneous mucinous carcinoma cases in the National Cancer Institute's Surveillance, Epidemiology, and End Results data (1972-2013) were analyzed to provide demographic, cancer-related, and treatment information and to calculate incidence and mortality. Patients were stratified by stage (local, regional, distant disease) for comparison. The risk of developing an SPM was calculated. RESULTS: Four hundred eleven PCMC cases were identified. The age-adjusted incidence was 0.04 cases per 100,000-person years. Blacks were disproportionately affected by PCMC (0.048; 95% confidence interval, 0.034-0.065; p < .001). Approximately 67.4% of patients had local disease, 10.5% had regional disease, and 5.8% had distant disease. Primary cutaneous mucinous carcinoma-specific mortality was independent of sex, age, race, primary site, histologic tumor grade, tumor size, tumor stage, or treatment. The overall frequency of developing a second primary malignancy was not increased in patients with PCMC. CONCLUSION: Although PCMC occurs with equally in both sexes, it may be more common in African Americans than previously recognized. Although eyelid PCMC may have a higher rate of distant metastasis, all patients need close follow-up.

Aggressive Digital Papillary Adenocarcinoma: Population-Based Analysis of Incidence, Demographics, Treatment, and Outcomes.

BACKGROUND: As a rare cutaneous malignancy, epidemiologic and outcomes data for aggressive digital papillary adenocarcinoma (ADPA) are limited and no treatment guidelines exist. OBJECTIVE: To provide a population-based study of ADPA incidence and outcomes with a subgroup comparison of patients with localized versus regional disease. METHODS: Data from 18 registries within the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program were examined for patients with ADPA (1995-2013) to provide demographic- and cancer-related information, and to calculate race- and age-specific rate ratios, incidence, and mortality. Patients were stratified by the stage for further comparison. RESULTS: Ninety-four cases of ADPA were identified. Overall, ADPA incidence was 0.08 per 1,000,000 person-years, 4 times higher in males than in females (0.13 vs 0.03, p < .001), and most common in Caucasians. Regional disease spread occurred in 22.3% of patients and disease-specific mortality in 2.1% of patients. Patients with regional versus localized disease at diagnosis did not differ significantly in sex, age, race, primary site, tumor size, or mortality. CONCLUSION: Aggressive digital papillary adenocarcinoma is a rare malignancy with increasing incidence. Regional disease spread is not infrequent, but mortality is rare. Identification of patients best suited for additional diagnostic procedures or more extensive surgical resection remains challenging.

Pyogenic liver abscesses: a contemporary analysis of management strategies at a tertiary institution.

BACKGROUND: Despite equivocal evidence, non-surgical management for pyogenic liver abscess (PLA) has become the standard of care at most institutions with surgery relegated to salvage therapy for those who fail less invasive means. The aim of this study was to describe the outcomes of a step-up approach to PLA management. METHODS: A retrospective chart review was conducted at a single institution for patients diagnosed with PLA over a 10-year period. Demographic, radiologic, microbiological, treatment, and outcomes data were collected and analyzed. RESULTS: 64 patients with PLA were identified. Initial treatment included antibiotics alone (n = 9), percutaneous drainage (PD) (n = 54), and surgery (n = 1). Surgery was ultimately required in 8 patients while 50 were cured with PD and 4 with antibiotics alone. Two (3%) patients died. Overall, PD carried an 85% success rate. CONCLUSION: PLA patients should be initially treated non-operatively, barring indications for emergent surgery or inaccessibility for PD. Surgery can be reserved for failure of PD.