Non-tuberculous mycobacterial infections following cosmetic laser procedures: a case report and review of the literature.

Skin infections are not uncommon after cosmetic laser procedures. Infection rates following ablative laser resurfacing procedures are reported to be as high as 7.6%, compared to 1.9% for fractional ablation. An infrequent yet important infectious complication of ablative laser treatment is that caused by non-tuberculous mycobacteria (NTM).

Role of human papillomavirus in cutaneous squamous cell carcinoma: a meta-analysis.

BACKGROUND: The role of human papillomavirus (HPV) in cutaneous squamous cell carcinoma (cuSCC) is not well defined, with past studies showing conflicting results. OBJECTIVE: We sought to determine if there is a significant association between HPV and cuSCC and whether cuSCC from immunosuppressed patients are more likely to carry HPV than cuSCC from immunocompetent patients. METHODS: We performed a systematic review and abstracted data from articles that included: skin samples by biopsy, HPV detection by polymerase chain reaction, and a minimum of 10 cases and 10 controls. Pooled effect size and 95% confidence intervals were calculated using random effects meta-analysis using the inverse variance method. RESULTS: cuSCC were more likely to carry HPV than normal-appearing skin (pooled effect size [ES] 3.43, 95% confidence interval 1.97-5.98, P < .0001) in all patients. An increase in HPV prevalence was found in tumors from immunosuppressed patients compared with immunocompetent patients (pooled ES 3.01, 95% confidence interval 2.00-4.52, P < .0001). LIMITATIONS: The greatest limitation is the heterogeneity of the studies included. The association of higher HPV prevalence in squamous cell carcinoma compared with normal-appearing skin does not imply causality. CONCLUSION: These results contribute to evidence that HPV is associated with cuSCC. Higher HPV burden in tumors from immunosuppressed patients compared with immunocompetent patients may have therapeutic implications.

Reconstruction of scalp wounds with exposed calvarium using a local flap and a split-thickness skin graft: case series of 20 patients.

OBJECTIVES: To describe the design, execution, outcomes, and advantages of a combined flap and split-thickness skin graft reconstructive technique for the repair of wounds of the scalp with exposed bone after Mohs micrographic surgery. MATERIALS AND METHODS: An analysis of the combined flap and graft technique of 20 scalp defects ranging in size from 6.25 to 37.6 cm(2) is provided. Surgical defects and patient characteristics are described. Follow-up information is reviewed, and complications and final aesthetic results are reported. RESULTS: Twenty patients with 20 tumors on the scalp (16 squamous cell carcinoma, 2 basal cell carcinoma, 1 Merkel cell carcinoma, and 1 malignant fibrous histiocytoma) were treated using Mohs micrographic surgery. A combined flap and graft technique was successfully employed with good aesthetic outcomes in all 20 patients with broad scalp defects. One postoperative complication of approximately 20% skin graft necrosis was noted. One methicillin-resistant Staphylococcus aureus postoperative wound infection occurred but resolved without sequelae with appropriate antibiotic treatment. CONCLUSION: The described flap and graft reconstructive technique is a reproducible, one-stage procedure for the reconstruction of medium to large scalp defects with exposed bone, obviating the need for more-complicated, costly, time-consuming procedures. LIMITATIONS: Small sample size, descriptive study.

Multidisciplinary management of advanced basal cell carcinoma: report of four cases.

BACKGROUND: Advanced basal cell carcinomas (BCC) are neoplasms with high-risk clinical characteristics that can develop as locally advanced disease or metastasis. Treatment of advanced BCC may result in significant morbidity due to the technical challenges of size and/or location or in which surgery and radiation therapy may be contraindicated. No standard of care exists for the management of advanced BCC. As such, the difficulty in managing these tumors necessitates a multidisciplinary approach to patient care. METHODS: We report four cases of advanced BCC that benefited from a multidisciplinary approach, as well as highlight treatment considerations and factors in the development of advanced BCC. RESULTS: All four complex cases of advanced BCC presented to a multidisciplinary non-melanoma skin cancer tumor board with extensive tumor involvement. Treatment of disease was effective in preventing recurrence while optimizing aesthetic outcomes. CONCLUSIONS: The multidisciplinary tumor board has a central and important role in the evaluation and management of advanced BCC.

Prospects for personalized targeted therapies for cutaneous squamous cell carcinoma.

Targeted therapies for cutaneous squamous cell carcinoma (cSCC) remain limited. Extensive genetic heterogeneity complicates a robust molecular characterization of the evolution of cSCC. Nonetheless, potential targeted therapies for this cancer are under investigation, including the inhibition of epidermal growth factor receptor (EGFR), which may yield promising results. In addition, the emergence of immune checkpoint blockade therapy and vaccine-based methods may provide novel treatment strategies for cSCC that are tailored to the individual patient. Ultimately, a combination of such methods may yield a multi-pronged targeted approach to personalize the treatment of cSCC.

Merkel cell carcinoma: current status of targeted and future potential for immunotherapies.

Merkel cell carcinoma is an aggressive neuroendocrine tumor with a high incidence of local recurrence, regional nodal and distant metastasis, and a high mortality rate. It has been linked to a polyomavirus in addition to immune suppression. Traditionally, treatment options have been limited to surgery and radiation therapy. Better understanding of the molecular pathways of infection and carcinogenesis has provided potential molecular targets and potential immunotherapies which are discussed in this review.

Cutaneous squamous cell carcinoma and human papillomavirus: is there an association?

BACKGROUND: The role of human papillomavirus (HPV) in the induction and maintenance of cervical, anogenital, and some oropharyngeal carcinomas is well recognized, but its role in cutaneous squamous cell carcinoma (SCC) remains to be elucidated. HPV is thought to act as a possible cocarcinogen in the development of SCC. OBJECTIVE: To review the literature assessing the correlation between and possible causation of HPV and cutaneous SCC in immunocompetent and immunocompromised populations. METHODS: We reviewed HPV sampling and detection methods, epidemiologic studies examining HPV carriage in immunocompetent and immunosuppressed individuals, and evidence asserting an association between HPV and cutaneous SCC. RESULTS: Although an abundant body of evidence points toward a link between HPV and cutaneous SCC, many studies indicate otherwise. Recent studies have focused on viral activity in addition to DNA presence. CONCLUSION: The possibility exists that HPV may play a role in the induction but not maintenance of cutaneous SCC.

Pathologic features of pediatric head and neck melanoma.

Although malignant melanoma is rare in children, its incidence is steadily increasing, and it is potentially lethal. Few studies have examined head and neck melanoma in children, and even fewer have focused on the histopathologic features of melanoma within this anatomic region. To further the understanding of this entity, we examined pathology specimens from nine subjects age 18 years and younger with an original diagnosis of head or neck melanoma. The anatomic locations of these primary melanomas were the face and nose (n = 4), scalp and neck (n = 4), and ear (n = 1). The cases included seven superficial spreading melanomas, one unclassified (possible nodular) melanoma, and one melanoma in situ. No melanomas demonstrating desmoplastic or spindle cell morphologies were noted upon review. Breslow depth ranged from 0 to 2.9 mm (mean 1.3 mm, median 0.6 mm), with Clark level ranging from I to V. Pagetoid scatter was found in eight cases. Other notable features included regression (n = 5), ulceration (n = 1), and associated melanocytic nevus (n = 4). We did not observe any small cell variants; all nine cases had an epithelioid appearance. Nor was any melanoma-associated mortality observed at last follow-up (mean 60.4 mos, median 48 mos, range 2-174 mos). These histopathologic features were consistent with adult-type melanoma, which is in agreement with other histopathologic studies of melanoma in children.

Verruciform xanthoma of the earlobe in an immunosuppressed patient.

Verruciform xanthoma (VX) is an uncommon mucocutaneous lesion of uncertain etiology. Originally thought to be limited to the oral mucosa, its occurrence in other mucosal and nonmucosal sites also has been documented. Histologically, VX is characterized by subepithelial foamy histiocytes associated with papillomatosis, parakeratosis, and dyskeratosis. Subepithelial foamy cells are lipid-containing, non-Langerhans cell histiocytes. A variety of etiologies have been proposed without much consensus, including infectious (bacterial, viral, and fungal), degenerative, reactive/ reparative, inflammatory, metabolic, reactive/ multifactorial, and immunosuppressive factors. Verruciform xanthoma of the external ear is exceedingly rare. Herein, we report a rare case of VX occurring on the earlobe at a piercing site in an immunosuppressed patient and provide a discussion of the possible pathogenetic mechanism(s).

Leukemia cutis in association With Grover's disease.

Grover's disease (GD), or transient acantholytic dermatosis, is a persistent recurrent dermatosis that usually occurs in men older than 50 years. Rare cases of GD and hematologic malignancy in the same cutaneous biopsy specimen have been reported. We report a case of GD in association with leukemia cutis. A 72-year-old man with a history of myelodysplastic syndrome presented with numerous pruritic papules on the torso, which were clinically diagnosed as GD. A skin biopsy revealed foci of suprabasal acantholysis and dyskeratosis consistent with GD and dense aggregates of mononuclear atypical cells in the superficial dermis consistent with leukemia cutis. Direct immunofluorescence was negative. This case illustrates the need to consider a diagnostic skin biopsy in any patient who presents with classic clinical findings of GD if there is any indication that the patient may be at higher risk for a hematologic malignancy.

Molluscum contagiosum involving an epidermoid cyst with xanthogranuloma-like reaction in an HIV-infected patient.

BACKGROUND: Molluscum contagiosum (MC) causes characteristic cutaneous lesions that occur mainly in children, sexually active adults, and immunocompromised individuals, especially those with human immunodeficiency virus (HIV) infection. Patients infected with HIV, particularly those with advanced disease, have an increased incidence, up to 33.3%, of MC in non-anogenital areas. MC has been rarely found to be associated with epidermoid cysts. CASE REPORT: A 44-year-old male with HIV infection presented with the complaint of a-3-month history of a tender nodule on the left neck. H&E stained sections showed a ruptured cyst, lined with squamous epithelium showing cytopathic changes of MC, and a xanthogranuloma-like inflammatory reaction with characteristic Touton-type giant cells. CONCLUSION: MC infections are common, however MC associated with epidermoid cysts is infrequent. A few cases of MC occurring in epidermoid cysts have previously been reported. We are presenting a case of MC involving an epidermoid cyst in an AIDS patient, with a unique xanthogranuloma-like reaction. Xanthogranulomatous (XG) reactions have been infrequently reported in association with other viral infections, however, poxvirus-associated XG reaction has only been observed in animals. This is the first reported case of MC-associated XG reaction in humans.

Eruptive neutrophilic xanthomas.

Cutaneous eruptive xanthomas are characteristics lesions of hyperlipidemia. Rarely,these lesions may present with prominent leukocytoclasis as seen in papular neutrophilic xanthomas, which have been described in HIV positive and immunocompromised patients. Herein we describe a patient with eruptive neutrophilic xanthomas with neither hyperlipidemia nor immunocompromise. Moreover, these lesions improved with sun and UV light exposure.

Plexiform pattern in cutaneous granular cell tumors.

Granular cell tumors, considered to be of peripheral nerve sheath origin, can involve various parts of the body with skin and tongue being the most common organs involved. In the skin, the granular cell tumors usually form an ill-defined mass of round to oval cells with abundant eosinophilic granular cytoplasm and central or eccentric bland nuclei. Here we present nine cases of granular cell tumors, which display features different from the classical cutaneous granular cell tumor and have features similar to the earlier described plexiform granular cell tumors. Plexiform pattern in granular cell tumors may be more common than is reported.

Advice for medical students interested in dermatology: perspectives from fourth year students who matched.

We present perspectives from four fourth year medical students who matched into dermatology that highlight the factors they believed helped them most. The purpose is to offer advice to medical students interested in dermatology. We divide the paper into four areas of discussion: academics, extracurricular activities, research, and mentorship. All four factors are crucial for a strong dermatology application. We believe the paper provides valuable suggestions and guidance to students considering a career in dermatology.

MyD88 regulation of Fusarium keratitis is dependent on TLR4 and IL-1R1 but not TLR2.

The fungal pathogens Fusarium solani and Fusarium oxysporum cause severe corneal disease in the United States and worldwide and were the causative organisms in a recent outbreak of contact lens-associated keratitis. To characterize innate immunity in Fusarium keratitis, we developed a murine model in which conidia are injected into the corneal stroma. Immunocompetent C57BL/6 mice rapidly developed severe corneal opacification associated with neutrophil infiltration and clearance of Fusarium hyphae. In contrast, neutrophil infiltration was delayed in MyD88-/- mice, resulting in uncontrolled growth of Fusarium hyphae in the corneal stroma and anterior chamber, and eventually resulting in corneal perforation. Corneal opacification scores in TLR2-/-, TLR4-/-, and TLR2/4-/- mice were similar to those of C57BL/6 mice; however, TLR4-/- and TLR2/4-/- mice had impaired antifungal responses. The phenotype of infected IL-1R1-/- mice was similar to that of MyD88-/- mice, with uncontrolled fungal growth resulting in corneal perforation. IL-1R1-/- mice also produced significantly less CXCL1/KC in the corneal stroma compared with C57BL/6 mice consistent with delayed neutrophil recruitment to the corneal stroma. Together, these findings indicate that IL-1R1 and MyD88 regulate CXC chemokine production and neutrophil recruitment to the cornea, and that TLR4 has an important role in controlling growth and replication of these pathogenic fungi.