Bullous lichen sclerosus: isolated vulvar involvement.

We present a patient with the bullous form of lichen sclerosus of the vulva. She had no lesions in other cutaneous and mucosal areas. We used topical tacrolimus and topical clobetasol propionate. The patient was lesion free at the first-year follow-up.

Vulvar syringomas as a part of nonfamilial generalized eruptive form: Unusual lesions leading to pseudohyper-trophy of the labia majora.

We present a case of eruptive generalized syringoma with vulvar involvement. This case is unique in terms of being a nonfamilial, linear variant, leading to pseudohypertrophy of the labia majora.

Is there an association between flow diverter fish mouthing and delayed-type hypersensitivity to metals?-a case-control study.

PURPOSE: Flow diverters are increasingly used in the treatment of complex and giant intracranial aneurysms. However, they are associated with complications like late aneurysmal rupture. Additionally, flow diverters show focal structural decrease in luminal diameter without any intimal hyperplasia. This resembles a "fish mouth" when viewed en face. In this pilot study, we tested the hypothesis of a possible association between flow diverter fish-mouthing and delayed-type hypersensitivity to its metal constituents. METHODS: We retrospectively reviewed patient records from our center between May 2010 and November 2015. A total of nine patients had flow diverter fish mouthing. A control group of 25 patients was selected. All study participants underwent prospective patch test to detect hypersensitivity to flow diverter metal constituents. Analysis was performed using logistic regression analysis and Wilcoxon sign rank sum test. Univariate and multivariate analyses were performed to test variables to predict flow diverter fish mouthing. RESULTS: The association between flow diverter fish mouthing and positive patch test was not statistically significant. In multivariate analysis, history of allergy and maximum aneurysm size category was associated with flow diverter fish mouthing. This was further confirmed on Wilcoxon sign rank sum test. CONCLUSION: The study showed statistically significant association between flow diverter fish mouthing and history of contact allergy and a small aneurysmal size. Further large-scale studies are needed to detect a statistically significant association between flow diverter fish mouthing and patch test. We recommend early and more frequent follow-up imaging in patients with contact allergy to detect flow diverter fish mouthing and its subsequent evolution.

Impact of Radiation Therapy on Serum Humanin and MOTS-c Levels in Patients with Lung or Breast Cancer.

BACKGROUND: Lung and breast cancer are the most frequent causes of death from cancer globally. The objectives of this research were to evaluate the serum mitochondrial open reading frame of the 12S rRNA-c (MOTS-c) and humanin levels in lung or breast cancer patients, and investigate the impacts of radiation therapy on the circulating levels of these peptides. METHODS: 35 lung cancer patients, 34 breast cancer patients, and healthy volunteers as a control group were recruited in this prospective observatory research. Lung cancer patients with stage IIIA/IIIB were treated with paclitaxel-based chemotherapy plus radiotherapy (2 Gy per day, 30 times, 60 Gy total dose). Breast cancer stage IIA/IIB patients were treated with postoperative locoregional radiation therapy (2 Gy per day, 25 times, 50 Gy total dose). The ELISA method was used to detect serum humanin and MOTS-c levels during, before, and after radiotherapy. RESULTS: We observed marked elevations in circulating MOTS-c, but not humanin levels in patients with lung cancer (P < 0.001). Radiation therapy led to a marked augmentation in MOTS-c levels in these patients (P < 0.001). On the other hand, there was a marked decline in humanin, but not MOTS-c, levels in breast cancer patients (P < 0.001). CONCLUSION: Our research has shown, for the first time, that increased MOTS-c and decreased humanin levels play a role in lung cancer and breast cancer, respectively. Additionally, radiotherapy modifies MOTS-c levels in patients with lung, but not breast cancer.

Bilateral and symmetrical tinea mammae.

Tinea corporis has rarely been reported in some locations such as on the breast skin as unilaterally. Herein, we present a case of bilateral tinea mammae, which has not been reported before in English language literature to our knowledge.

The Relationship Between Disease Activity and Platelet Indices in Pemphigus: An Observational Preliminary Study.

Tests which have proven their efficacy and reliability in the follow-up of pemphigus patients are used only on a limited scale or take time to complete due to a lack of technical facilities in several centers. Therefore, more accessible methods are being considered for monitoring disease activity. We aimed to investigate the relationship between platelet function and disease activity based on the change in proinflammatory cytokine profile in pemphigus pathogenesis. The size of platelets correlates positively with their activity. Platelet sizes can be evaluated by the platelet volume index consisting of mean platelet volume (MPV), platelet-crit (PCT), and platelet distribution width (PDW). These indicators can be easily measured in complete blood count (CBC) with automatic blood counting devices, which do not require additional costs and are readily available. Patients diagnosed with pemphigus between April 2010 and February 2016 (n=18) in our center were retrospectively included in the study. Demographic data, follow-up period, clinical variants of the patients, platelet parameters (MPV, PDW, PCT), and platelet count (PLT) in CBC analysis with concurrent clinical activity, as well as indirect immunofluorescence (IIF) findings (positive highest titer) at the 6th and 12th month were recorded for each patient. MPV changes were consistent with the course of the disease. A statistically significant decrease in PCT levels was observed at the 12th month compared with the baseline levels (P<0.05). According to the baseline measurement, a statistically significant positive correlation (58.9%) was found between the 12-month difference measurements of IIF and PCT. Our data demonstrated that PCT decrease is correlated with IIF values. The significant correlation between PCT and IIF values in our study is important in showing the possible role of platelet index in the measurement of disease activity.

Impact of respiratory motion on lung dose during total marrow irradiation.

We evaluated the impact of respiratory motion on the lung dose during linac-based intensity-modulated total marrow irradiation (IMTMI) using two different approaches: (1) measurement of doses within the lungs of an anthropomorphic phantom using thermoluminescent detectors (TLDs) and (2) treatment delivery measurements using ArcCHECK where gamma passing rates (GPRs) and the mean lung doses were calculated and compared with and without motion. In the first approach, respiratory motions were simulated using a programmable motion platform by using typical published peak-to-peak motion amplitudes of 5, 8, and 12 mm in the craniocaudal (CC) direction, denoted here as M1, M2, and M3, respectively, with 2 mm in both anteroposterior (AP) and lateral (LAT) directions. TLDs were placed in five selected locations in the lungs of a RANDO phantom. Average TLD measurements obtained with motion were normalized to those obtained with static phantom delivery. The mean dose ratios were 1.01 (0.98-1.03), 1.04 (1.01-1.09), and 1.08 (1.04-1.12) for respiratory motions M1, M2, and M3, respectively. To determine the impact of directional respiratory motion, we repeated the experiment with 5-, 8-, and 12-mm motion in the CC direction only. The differences in average TLD doses were less than 1% when compared with the M1, M2, and M3 motions indicating a minimal impact from CC motion on lung dose during IMTMI. In the second experimental approach, we evaluated extreme respiratory motion 15 mm excursion in only the CC direction. We placed an ArcCHECK device on a commercial motion platform and delivered the clinical IMTMI plans of five patients. We compared, with and without motion, the dose volume histograms (DVHs) and mean lung dose calculated with the ArcCHECK-3DVH tool as well as GPR with 3%, 5%, and 10% dose agreements and a 3-mm constant distance to agreement (DTA). GPR differed by 11.1 ± 2.1%, 3.8 ± 1.5%, and 0.1 ± 0.2% with dose agreement criteria of 3%, 5%, and 10%, respectively. This indicates that respiratory motion impacts dose distribution in small and isolated parts of the lungs. More importantly, the impact of respiratory motion on the mean lung dose, a critical indicator for toxicity in IMTMI, was not statistically significant (p > 0.05) based on the Student's t-test. We conclude that most patients treated with IMTMI will have negligible dose uncertainty due to respiratory motion. This is particularly reassuring as lung toxicity is the main concern for future IMTMI dose escalation studies.

A cutaneous metastasis of bronchogenic carcinoma: Milia-like lesions with dermatomal pattern.

Clinical presentation of cutaneous metastases is often variable. Presented case had an intriguing cutaneous metastasis of bronchogenic squamous cell carcinoma. Lesions were characterized by dermatomal pattern with milia-like papules, plaques, and nodules.

Lipedematous scalp: a rare entity.

Lipedematous scalp is characterized by increased subcutaneous thickness of the scalp without any hair change. A 50-year-old female presented with thickening of the scalp without alopecia. She had no disorder other than hypertension. Monthly sonographic measurements without any treatment showed a resolution tendency in some areas and an increased thickness in others. We discuss the characteristics of this rare and possibly underestimated entity, including differential diagnoses.

Preliminary study among truck drivers in Turkey: effects of ultraviolet light on some skin entities.

In this study, we aimed to compare driver (left) and opposite (right) sides for some skin entities in drivers. We also evaluated the effect of occupational duration, age and skin type among this population. One hundred and forty-eight truck drivers were included in this study. Sun exposed areas were classified. Dermatological entities such as actinic keratosis, solar lentigo, seborrheic keratosis, melanocytic nevus, spider angioma, ephelid, basal cell carcinoma (BCC), squamous cell carcinoma, and melanoma were compared to driver and right sides. In addition, drivers were divided into two subgroups according to: (i) age (subgroups A1, 20-40 years, and A2, >40 years); (ii) occupational duration (subgroups O1, 1-10 years, and 02, >10 years); and (iii) skin type (subgroups S1, skin types I and II, and S2, skin types III and IV. Each of the two subgroups were compared with respect to the total prevalence (left and right sides) of lesions excluding the location. Seborrheic keratosis and lentigo solaris were found to be increased on the driver side of the face (P = 0.00) and ear (P = 0.013), respectively. Statistically significant increases of lesions on the driver side were determined according to the subgroups: melanocytic nevi were found to be increased on the driver side in A1 (P = 0.00), A2 (P = 0.00), O2 (P = 0.00), S1 (P = 0.00) and S2 (P = 0.006) groups; actinic keratoses were found to be significantly increased on the driver side in A2 and O2 groups (P = 0.03 for both).

Melkersson Rosenthal syndrome associated with ipsilateral facial, hand, and foot swelling.

Melkersson-Rosenthal syndrome is a complex neuromucocutaneous disorder. A 60-year-old woman presented with granulomatous cheilitis of the lower lip, unilateral facial paralysis, and ipsilateral facial and acral swelling. The result of histopathological evaluation in extremities and inferior lip was compatible with Melkersson-Rosenthal syndrome.

Scrotal Kaposi's Sarcoma in HIV-negative patient: A case report and review of the literature.

Kaposi's Sarcoma (KS) is a malignancy that generally effects the skin, and can be systemic with internal organ involvement. It originates from the vascular endothelium. KS's relationship with human immunodeficiency virus (HIV) infection is well known. Isolated scrotal KS in the urogenital system is quite rare and scrotal KS in an HIV-negative patient is limited to a few cases. In this case report, the biopsy result from the violescent nodular lesions on the scrotum of the HIV-negative 81-year-old patient was found compatible with KS and a pathology was not detected in the systemic screening. With a diagnosis of isolated scrotal KS, the patient underwent surgical excision aimed at the lesions on the scrotum. KS is rare in HIV-negative patients and it is associated with human herpes virus-8 infection.

Cutaneous metastasis in prostate cancer: Two cases with similar clinical findings.

Cutaneous metastasis of prostate cancer is rare. Lesions in this type of skin metastasis are usually seen as suprapubic nodules. Here, we presented two cases with skin metastases of prostate cancer characterized by grouped cutaneous and subcutaneous nodules.

Subungual osteochondroma: a diagnostic dilemma.

Osteochondroma is the most common skeletal neoplasm of all benign bone tumors. However, it rarely occurs subungually. In this location, the lesion may penetrate the skin, causing nail deformity, and can easily be misdiagnosed. We report two cases of subungual osteochondroma of the distal phalanges of the first toes with cutaneous penetration and discuss the clinical, histologic, and radiographic features and the treatment options.

Skin diseases of the nose.

OBJECTIVES: The goal of this study was to review the main lesion types of the nasal skin and appropriate treatment strategies rather than to present a comprehensive list of all diseases that affect the skin that can involve the nose. METHODS: We reviewed the main nasal skin lesion types and available treatment strategies. Nasal skin lesions were classified as benign, premalignant, or malignant. RESULTS: Benign lesions of the nose include nonmalignant tumoral lesions (i.e., freckles, comedo, adenoma sebaceum [Pringle disease], hydrocystoma, fibrous papules, sebaceous hyperplasia, and rhinophyma), autoimmune and inflammatory conditions (i.e., pemphigus, sarcoidosis, systemic lupus erythematosus, facial eosinophilic granuloma, rosacea, herpes zoster infection, leishmaniasis, and leprosy), and vascular lesions (i.e., telangiectasis, hemangioma, and spider nevus). Premalignant lesions are actinic keratosis and keratoacanthoma; and malignant tumors are melanoma, basal cell carcinoma, and squamous cell carcinoma. Regardless of whether or not they are malignant, all facial lesions can yield significant cosmetic discomfort that should be evaluated carefully before commencing any curative or corrective intervention. In general, benign lesions are treated with dermabrasive modalities, such as trichloroacetic acid, phenol, salicylate, and laser ablation. Electrocautery, cryosurgery, and surgical excision are also used, although these methods may result in scar formation, which can sometimes be more problematic than the original lesion itself. CONCLUSION: Any disease that affects the skin, especially those diseases that are triggered by ultraviolet exposure, can involve the face and nose. Cosmetic defects due both to the lesion itself and the intervention must be discussed with the patient, preferably in the presence of a first-degree relative, before commencement of treatment. As a result of heterogeneity of skin lesions of the nose, appropriate education of general practitioners as well as otorhinolaryngologists is mandatory.

Simultaneous onset of pemphigus vulgaris in two Turkish siblings.

The etiology of pemphigus vulgaris is still unknown. Reported familial cases are indicators of a genetic aspect of the disease. We report a brother and sister with simultaneous onset of pemphigus vulgaris. The class II antigens, HLA DRB1*04 and DQB1*03 were detected in both patients. The oral mucosa was affected in one them. Elevation of transaminase levels due to azathioprine therapy was observed in these two cases.

A neglected case of macrodystrophia lipomatosa of the foot in an elderly man.

Macrodystrophia lipomatosa is a rare disorder characterized by three-dimensional enlargement of one or more fingers or toes with predominantly fibroadipose tissue. Radiographically, it appears as hypertrophy of soft tissues and bones. The pathologic findings are infiltration and hypertrophy of adipose tissue in subcutaneous tissue, nerve sheaths, and periosteum. Macrodystrophia lipomatosa is usually diagnosed during childhood. The case presented here involves the most elderly patient with the condition ever reported, to our knowledge. As such, it may advance current knowledge of macrodystrophia lipomatosa. Special emphasis is given to the unique "bridge" formation seen radiographically in this case.