Cutaneous Lesions of Multiple Myeloma of the Lower Extremity Masquerading as Squamous Cell Carcinoma.

Cutaneous involvement in multiple myeloma (MM) is a rare manifestation, being more prevalent in patients with aggressive subtypes, and refractory to standard therapies. Due to the rarity of this diagnosis, the reported clinical characteristics have been protean and relatively non-specific. Lower extremity involvement of cutaneous MM is an uncommon anatomical location for this diagnosis. We present a patient with refractory IgG lambda MM, and a past medical history of squamous cell carcinoma of the lower extremities who developed cutaneous MM in his lower leg. At the time of initial evaluation, the lesions mimicked squamous cell carcinoma, posing a diagnostic challenge. Histopathological and immunohistochemical studies confirmed cutaneous involvement by multiple myeloma. There needs to be a high clinical suspicion for cutaneous MM in patients with MM presenting with new skin lesions.

Primary cutaneous follicle center lymphoma mimicking folliculitis.

Primary cutaneous follicle center lymphoma (PCFCL) is the most common type of cutaneous B-cell lymphoma. The cutaneous manifestations of PCFCL typically include solitary erythematous or violaceous plaques, nodules, or tumors of varying sizes. Grouped lesions also may be observed, but multifocal disease is rare. We report the case of a 54-year-old woman diagnosed with PCFCL with an unusual clinical presentation resembling folliculitis or Grover disease. Histologic studies demonstrated extensive lymphoma cells in a nodular and diffuse pattern. Immunohistochemical studies demonstrated that the neoplastic cells were positive for CD20, CD79a, BCL-2, and BCL-6; CD3, CD5, and cyclin D1 were negative. These findings were consistent with PCFCL. Further evaluation for systemic disease via positron emission tomography-computed tomography and bone marrow biopsy was unremarkable. Increased awareness of this presentation of PCFCL can facilitate earlier diagnosis and intervention, which may result in improved patient outcomes.

Improvement in Patient Performance of Skin Self-examinations After Intervention With Interactive Education and Telecommunication Reminders: A Randomized Controlled Study.

OBJECTIVE To determine if interactive computerized patient education, skin self-examination (SSE) tutorials, and telecommunication reminders could be combined to increase patient performance of SSEs, increase confidence in ability to identify melanoma, and influence individual melanoma risk perception. DESIGN A total of 132 adult participants from our dermatology clinics were enrolled in an interventional study and randomized to a control group or an intervention group. Survey data were collected from all participants on the day of enrollment and 3 months after enrollment. SETTING University Hospitals Case Medical Center outpatient dermatology clinics. PARTICIPANTS English speakers older than 18 years. INTERVENTIONS The intervention group (1) participated in a computer-assisted learning tutorial, (2) took part in a hands-on SSE tutorial, (3) received monthly telecommunication reminders to perform SSEs for 12 weeks, and (4) received a brochure on melanoma detection. The control group received only the brochure on melanoma detection. MAIN OUTCOME MEASURES Self-report of performance of SSEs. Melanoma risk perception and confidence in ability to identify melanoma were secondary considerations. Logistic regressions, controlling for race, age, sex, education, and family history of melanoma, were used to assess the effectiveness of the intervention. RESULTS At the 3-month follow-up, those in the intervention group were more likely to perform SSEs (odds ratio [OR], 2.36; P ≤ .05). In addition, those who participated in the intervention were more likely to report being confident in their ability to identify melanoma during an SSE (OR, 2.72; P ≤ .05). CONCLUSION Computer-assisted patient education used in conjunction with a hands-on SSE tutorial and telecommunication reminders can increase patient performance of SSEs and confidence in the ability to identify melanoma.

Association of increased dermatologist density with lower melanoma mortality.

OBJECTIVE: To determine whether there is an association between dermatologist density and melanoma mortality. DESIGN: A regression model was developed to test the association between melanoma mortality and dermatologist density, controlling for county demographics, health care infrastructure, and socioeconomic factors. Data were collected from the Area Resource File, US Centers for Disease Control and Prevention, and National Cancer Institute's Surveillance, Epidemiology, and End Results program and National Program for Cancer Registries. SETTING: US counties. PATIENTS: Melanoma mortality and incidence data were reported as age-adjusted mean rates per 100 000 people from January 2002, through December 2006. MAIN OUTCOME MEASURE: The primary outcome measure was melanoma mortality rate per 100 000 people at the county level. RESULTS: Geographic variation exists in the distribution of dermatologists across the United States. Multivariate analysis demonstrated that the presence of 0.001 to 1 dermatologist per 100 000 people was associated with a 35.0% reduction in the melanoma mortality rate (95% CI, 13.4%-56.6%) when compared with counties with no dermatologist. The presence of 1.001 to 2 dermatologists per 100 000 people was associated with a 53.0% reduction in the melanoma mortality rate (95% CI, 30.6%-75.4%). Having more than 2 dermatologists per 100 000 people did not further lower melanoma mortality rates. CONCLUSION: Within a given county, a greater dermatologist density is associated with lower melanoma mortality rates compared with counties that lacked a dermatologist.

Dermatitis in patients undergoing the Nuss procedure for correction of pectus excavatum.

BACKGROUND: The Nuss procedure was introduced in 1987 for the correction of pectus excavatum. In this procedure, a stainless steel bar is placed underneath the sternum. OBJECTIVES: To report cutaneous reactions associated with Nuss bar placement. METHODS: Over a period of 30 months, 50 patients underwent the Nuss procedure. The study population was limited to those who developed clinically significant cutaneous reactions postoperatively. Patient information was obtained from electronic medical records. All patients had been patch tested preoperatively with stainless steel discs supplied by the bar manufacturer. When performed, expanded patch testing was carried out in accordance with the North American Contact Dermatitis Group guidelines. RESULTS: Postoperatively, 3 patients developed areas of protuberant granulation tissue at one or more incision sites. One patient developed localized oedema, dermatitis, and lymphadenopathy. Two of these 4 patients underwent further patch testing. Of these 2, 1 with dermatitis had a positive reaction to nickel and the other, with granulation tissue, tested negative for metal allergy. CONCLUSIONS: Despite clinical evidence of cutaneous reactions or putative allergy, no patient required early removal of the bar(s). Cutaneous testing with stainless steel discs supplied by the bar manufacturer does not provide accurate screening for allergy to the implant used in the Nuss procedure.

Post-implantation erythema in 3 patients and a review of reticular telangiectatic erythema.

BACKGROUND: The appearance of erythematous, blanchable patches or plaques overlying an implant suggests possible reticular telangiectatic erythema (RTE). RTE is a benign reactive cutaneous manifestation that can present following the implantation of a cardiac pacemaker, defibrillator or intrathecal infusion pump in an otherwise asymptomatic, non-infectious patient. OBJECTIVE: To demonstrate the variety in clinical presentation of patients presenting with RTE or similar patch test-negative post-implantation erythema. PATIENTS/MATERIALS/METHODS: After institutional board approval had been obtained, patient information was obtained from electronic medical record files, which included surgical reports, pathology reports, and notes from outpatient encounters. RESULTS: We report post-implantation erythema following insertion of an elbow prosthesis, a knee prosthesis, and a spinal cord stimulator, which have not previously been cited as aetiologies of RTE. CONCLUSION: Owing to the delayed onset and variable recovery, RTE remains a diagnostic challenge. RTE should be included in the differential diagnosis of any patient presenting with erythema over the site of a previously implanted device.