Heterogeneity of blastomycosis-like pyoderma: A selection of cases from the last 35 years.

Blastomycosis-like pyoderma is a form of pyoderma with variable clinical findings and histopathological features. We present a case series of 39 patients collected over a 35-year period to demonstrate its clinical features and histological findings. The most common clinical presentations found were solitary plaques, solitary nodules, sinuses, crypts, verrucous plaques and discharge, usually on sun-exposed skin. The most common histopathological findings were chronic granulomatous inflammation, suppurative inflammation, sinus and abscess formation, pseudoepitheliomatous hyperplasia, transepidermal elimination and scarring. We discuss its treatment and the recent literature that has focused on its response to acitretin.

Squamous cell carcinoma and keratoacanthomas are biologically distinct and can be diagnosed by light microscopy: a review.

Keratoacanthomas (KAs) are self-limiting squamoproliferative lesions usually seen on sun damaged skin. These tumours are in many ways enigmatic, and the relation between KAs and squamous cell carcinoma is still a contested topic. In this review the biology and histology of KAs will be discussed, and based on morphology, clinical outcome and recent genetic analysis of the tumour types, we conclude that KAs and SCCs are two distinct biological entities which can usually be distinguished by conventional microscopy. The sentinel observation of rapid and frequent appearance of KAs after BRAF treatment of malignant melanoma patients has paved the way for a more general understanding of the pathogenesis leading to the appearance of KAs in patients with inflammation in the skin. In BRAF treated patients, the KAs are a consequence of paradoxical activation of the MAP kinase pathway. Similarly, any external trauma or pharmaceutical interventions resulting in inflammation in the skin will activate the MAP kinase pathway. Such inflammation-mediated MAP kinase activation in the skin will result in the development of KAs through the same pathway as demonstrated for BRAF treated patients. It is characteristic that skin tumours following short acting inflammatory stimulation of severely sun damaged skin develop almost exclusively into KAs, whereas it is exceedingly rare that such inflammatory conditions lead to formation of SCCs. The understanding that inflammatory reactions in sun-damaged skin may activate pathways specifically leading to the formation of KAs may spare the patient the discomfort and disfigurement of needless overtreatment.

Multiple lichen planus-like keratoses: Lichenoid drug eruption simulant and under-recognised cause of pruritic eruptions in the elderly.

We present six cases of multiple eruptive lichen planus-like keratoses (LPLK), occurring in older individuals predominately confined to previously solar exposed areas. Diagnosis was often confounded by the frequent histological reporting of 'lichenoid drug reaction' (LDR), despite many of the patients being unmedicated. We review the literature regarding eruptive LPLK and reflect on their etiology, clinical aspects, management and importantly their clinicopathological differentiation from LDR.

Is seborrhoeic dermatitis associated with a diffuse, low-grade folliculitis and progressive cicatricial alopecia?

An association between adult scalp seborrhoeic dermatitis and cicatricial hair loss has not previously been convincingly established. This study seeks to demonstrate a unique relationship between a clinically identifiable chronic scalp dermatitis-folliculitis with the characteristic histological features of low-grade inflammatory fibrosing alopecia, resulting in a distinctive progressive cicatricial alopecia which we believe is prevalent and hitherto unrecognised, and befits the description of seborrhoeic folliculitis. The clinical, epidemiological and histopathological features of seborrhoeic folliculitis are demonstrated to establish its unique status among the disorders of adult diffuse cicatricial alopecia.

Unstable solar lentigo: A defined separate entity.

An unstable solar lentigo is a solar lentigo with areas of melanocytic hyperplasia not extending past the margin of the lesion. They are discrete, macular, pigmented lesions arising on sun-damaged skin and a subset of typical solar lentigos. Clinically they differ from usual solar lentigines in often being solitary or larger and darker than adjacent solar lentigines. These lesions are of clinical importance as they can arise in close proximity to lentigo maligna and in a single lesion there can be demonstrated changes of solar lentigo, unstable solar lentigo and lentigo maligna. These observations led us to conjecture that unstable solar lentigos could be a precursor lesion to lentigo maligna. In this article we examine the possibility that lentigo maligna can arise within a solar lentigo through an intermediate lesion, the unstable solar lentigo. We propose that the histopathological recognition of this entity will allow for future research into its behaviour and thus management. We review difficulties in the diagnosis of single cell predominant melanocytic proliferations and the concept of unstable lentigo in view of the literature and clinical experience supporting the proposal of its recognition as a separate entity.

Prospective study of patterns of surgical management in adults with primary cutaneous melanoma at high risk of spread, in Queensland, Australia.

BACKGROUND: Knowledge of variation in diagnosis and surgery in high-risk primary melanoma patients is limited. We assessed frequency and determinants of diagnostic procedures, wide local excision (WLE) and sentinel lymph node biopsy (SLNB). METHODS: People in Queensland newly diagnosed with melanoma, clinical stage 1b or 2, were recruited prospectively. Patient information was collected from questionnaires and pathology records. Differences in surgical procedures in relation to host and tumor characteristics were assessed. RESULTS: In 787 participants, primary melanoma was diagnosed by surgical excision (74%), shave (14%), punch (12%) or incisional (1%) biopsy. General practitioners (GPs) diagnosed 80%. Diagnostic procedure differed by remoteness of residence, health sector, treating doctor's specialty and melanoma site and thickness. 766 patients had WLE, 86% by surgeons. Of 134 residual melanomas, 13 (10%) were ≤ 1 mm at diagnosis but > 1 mm at WLE, mostly after shave biopsy. SLNB was performed in 261 (33%) patients. SLNB was more common in those under 50, in remoter locations or treated by GP initially, and less common with head and neck melanoma. CONCLUSION: Diagnostic and surgical procedures for primary melanoma vary substantially and partial biopsy can influence initial tumor microstaging. Patient, tumor and doctor characteristics influence SLNB practice.

Acute cutaneous graft-versus-host disease resembling type II (atypical adult) pityriasis rubra pilaris.

We present a case of cutaneous acute graft-versus-host disease (aGVHD) with confluent erythematous perifollicular hyperkeratosis and ichthyosiform scale in the clinical pattern of type II (atypical adult) pityriasis rubra pilaris (PRP), which developed 26 days after allogeneic peripheral blood stem cell transplant. Skin histology confirmed features of both aGVHD and PRP. The skin lesions were refractory to oral prednisolone and cyclosporine and only partially responsive to a combination of i.v. methylprednisolone, oral tacrolimus, oral mycophenolate mofetil, and infusions of anti-thymocyte globulin and the tumour necrosis factor-α inhibitor, etanercept.

Dermatofibroma and halo dermatitis.

The occurrence of a halo of dermatitis surrounding acquired naevi was initially reported by Meyerson in 1971 with histological features of focal spongiosis, parakeratosis, irregular acanthosis and a lymphocytic infiltrate in the upper dermis. When the same inflammatory reaction occurs around other lesions it is referred to as the Meyerson phenomenon or halo dermatitis. We report a rare case of the Meyerson phenomenon occurring around a dermatofibroma in a 69-year-old woman. This case highlights that the phenomenon may occur in a broad range of clinical scenarios and is not limited to acquired naevi in young adults.

Dermoscopy improves diagnosis of tinea nigra: a study of 50 cases.

BACKGROUND/OBJECTIVES: Tinea nigra is a relatively uncommon dematiaceous fungal infection of the palms and soles, which clinically may mimic a melanocytic lesion. We sought to ascertain how frequently misdiagnosis of this infection occurred and whether the use of dermoscopy helped in its diagnosis. METHODS: Fifty consecutive cases of tinea nigra diagnosed at a dermatopathology laboratory were examined with regard to the clinical diagnosis, use of dermoscopy and the mode of management. RESULTS: Of the 50 cases, 21 (42.0%) were treated by shave or surgical excision. The clinical diagnosis of tinea nigra was made in five cases (10.0%) and suggested along with other diagnoses in a further two cases (4.0%). The dermatologists (n = 9) gave the correct diagnosis in four patients (44.4%), the general practitioners (n = 38) gave the correct diagnosis in one patient (2.6%) and the three surgeons involved did not give the correct diagnosis. When dermoscopy was used, in seven of 13 (53.8%) cases tinea nigra was suggested as a probable diagnosis but when dermoscopy was not used (n = 37) tinea nigra was not clinically diagnosed (P < 0.001). CONCLUSIONS: The diagnosis of tinea nigra is significantly improved by dermoscopy, the disease should be considered as a cause of palmar or plantar pigmentation.

Squamous cell carcinoma arising in keratoacanthoma: a neglected phenomenon in the elderly.

Keratoacanthoma is a unique clinicopathologic entity with a behavior and clinical outcome that differs markedly from that of squamous cell carcinoma. The development of squamous cell carcinoma in a keratoacanthoma alluded to by Rook and Whimster in 1979 and by Reed in 1993 was confirmed by Sánchez Yus et al in 2000. We found this phenomenon in 5.7% of keratoacanthomas in a series of 3465 cases. Its incidence in patients older than 90 years was 13.9%. The incidence of perineural invasion in this series of keratoacanthomas was 0.2%.

Mycobacterium abscessus infection complicating a professional tattoo.

A healthy 23-year-old man presented with a tender papular eruption confined to the grey pigment of a recently acquired professional tattoo. Atypical mycobacterial infection was suspected and culture of a tissue specimen grew Mycobacterium abscessus. He was successfully treated with minocycline and subsequently, clarithromycin. We present a brief review of M. abscessus infection, with a particular focus on its role in nosocomial infections and in the post-tattoo setting.

Primary cutaneous angioplasmocellular hyperplasia.

Primary cutaneous angioplasmocellular hyperplasia is a plasma-cellular infiltrate that has been reported only once previously in the literature, in a report of a case affecting two Latin American patients. In the present case, a systemically well 62-year-old Caucasian man presented with a nodule on the back of the neck. Histology showed a vascular proliferative process with an abundance of plasma cells in the stroma. There has been no recurrence of the lesion 2 years following curettage and diathermy. The clinicopathological presentation is consistent with primary cutaneous angioplasmocellular hyperplasia.

The top 100 cited neurorehabilitation papers.

BACKGROUND: Neurorehabilitation covers a large range of disorders, assessment approaches and treatment methods. There have been previous citation analyses of rehabilitation and of its subfields. However, there has never been a comprehensive citation analysis in neurorehabilitation. OBJECTIVE: The present study reports findings from a citation analysis of the top 100 most cited neurorehabilitation papers to describe the research trends in the field. METHODS: A de-novo keyword search of papers indexed in the Web of Science Core Collection database yielded 52,581 papers. A candidate pool of the 200 most-cited papers published between 2005 and 2016 was reviewed by the clinician authors. The papers in the top 100 deemed to be irrelevant were discarded and replaced by the most highly-cited articles in the second tier deemed to be clinically relevant. RESULTS: The most frequently cited neurorehablitation papers appeared in Stroke, Movement Disorders, and Neurology. Papers tended to focus on treatments, especially for stroke. Authorship trends suggest that top cited papers result from group endeavors, with 90% of the papers involving a collaboration among 3 or more authors. CONCLUSION: Treatment studies, often focused on stroke, appear to have the highest impact in the field of neurorehabilitation.