Imiquimod in the treatment of penile intraepithelial neoplasia: An update.

Penile intraepithelial neoplasia (PIN), or penile squamous cell carcinoma in situ, is a rare disease and may be associated with high morbidity and mortality. In an attempt to avoid surgical intervention, which may result in poor cosmetic and functional outcomes for patients, many non-invasive treatments have been trialled with variable success rates. This review summarises the available literature describing the use of topical imiquimod for PIN. While the results of our review are limited by the heterogeneity of the methods and follow ups of the included case series and case reports, they highlight the fact that patients with PIN have variable responses to imiquimod which seem less effective than previously reported. Therefore, if imiquimod treatment is instituted in PIN, clinicians should counsel their patients about the effects associated with treatment, the potential for a partial or no response to treatment, and the risk of recurrence. A strict follow-up plan is also necessary to monitor both patient adherence and PIN recurrence after treatment completion, in case surgical options need to be considered.

Cardiac arrest secondary to type 2 Kounis syndrome resulting from urticaria and angioedema.

A 43-year-old man with no cardiac history presented with chest pain followed by cardiac arrest. He was successfully defibrillated and underwent primary percutaneous coronary angioplasty to a culprit coronary artery lesion. He later re-presented with a diffuse urticarial rash and lip swelling, reporting that these symptoms had been present for 4 weeks before his cardiac arrest and voicing concern that a further cardiac arrest may be imminent. A diagnosis of post-viral or idiopathic autoimmune urticaria and angioedema was made. Given the absence of cardiac symptoms before the development of the rash, it was hypothesised that coronary artery spasm precipitated by histamine release due to his dermatological condition contributed to his myocardial infarction and cardiac arrest. The final diagnosis was therefore cardiac arrest secondary to type II Kounis syndrome, resulting from idiopathic autoimmune or post-viral urticaria and angioedema.

Severe, Malignant Acanthosis Nigricans Associated with Adenocarcinoma of the Endometrium in a Young Obese Female.

Acanthosis nigricans (AN) is a dermatopathy associated with insulin-resistance, drugs, endocrine disorders, chromosomal abnormalities (benign AN), and neoplasia (malignant AN). Malignant AN (MAN) is a rare paraneoplastic skin syndrome most commonly associated with gastric adenocarcinoma and other intra-abdominal malignancies. We report the case of a 28-year-old female with AN associated with obesity, insulin resistance, and endometrial adenocarcinoma. Although rare, MAN is often an initial sign of malignancy and must trigger extensive investigation, particularly in patients with sudden development of possibly paraneoplastic dermatoses or in patients diagnosed with benign AN with any atypical features.

One-fifth of basal cell carcinomas have a morphoeic or partly morphoeic histology: implications for treatment.

A retrospective analysis of the histopathology reports for all first or single basal cell carcinomas (1567) surgically treated over a 13-year period, was undertaken. Basal cell carcinomas classified by standard skin pathology nomenclature were divided into three groups: purely morphoeic basal cell carcinomas, partly morphoeic basal cell carcinomas and non-morphoeic basal cell carcinomas. A morphoeic or partly morphoeic histology was reported in 21.8% of basal cell carcinomas, particularly on the head and neck and in those over the age of 64 years. This percentage may increase further as patients live longer, and has important implications for treatment selection.