Successful radical surgical resection of a giant neurofibroma.

Large neurofibromas often cause significant patient morbidity and present a unique challenge to dermatologists and surgeons. Radical resection offers the lowest rate of recurrence but is not often pursued due to the high risk of intraoperative hemorrhage and difficulty in repairing large defects. Subtotal resection and debulking are more frequently performed, leading to higher rates of recurrence. This case highlights a particularly large neurofibroma and demonstrates how surgical techniques like preoperative embolization and advancement flaps can improve outcomes in the radical resection of large neurofibromas.

Learning dermatopathology in the digital age.

In recent years, advances in technology have allowed the study of pathology to transition into the digital realm. Histologic sections can now be viewed on mobile devices and computer screens easily and in many cases for free to increase exposure to representative learning cases. Many of these images have labels and markings to facilitate identification of key histologic findings. This article highlights some of the programs and Web sites that host these digital slides and rank them in the order of their utility to students of dermatopathology.

Simplifying sun safety: a guide to the new FDA sunscreen monograph.

Dermatologists are instrumental in educating their patients about safe sun practices. As residents, we should begin to instill this teaching point into our daily patient encounters. The new US Food and Drug Administration sunscreen guidelines, instituted fully in December 2012, help consumers make more educated decisions about sunscreens they purchase but also introduce new classifications and claims with which dermatologists should be intimately familiar. This article aims to concisely summarize the revisions as well as any continued controversies with the guidelines.

Stains and smears: resident guide to bedside diagnostic testing.

Dermatology residents often are on the front line when it comes to treating patients with complicated skin disorders, frequently seeing these cases first before discussing their findings and plan with an attending physician. Bedside testing modalities can help facilitate arriving at a diagnosis quickly, allowing for rapid initiation of treatment. The potassium hydroxide (KOH) preparation, Tzanck smear, mineral oil preparation, and Gram stain are easy to perform quickly and provide valuable diagnostic information. The purpose of this article is to consolidate these frequently used tests into a useful reference for the training and practicing dermatologist.

Giving a good needle: resident guide to decreasing injection pain.

Residency is a time when we set a foundation for how we will practice dermatology in the future. Perfecting good injection technique early in one's career can boost patient perception of the provider and help keep a schedule running smoothly. This resident guide focuses on ways we can give better injections by highlighting useful pearls to master this commonplace procedure.

Learning from a leader: an interview with Dirk M. Elston, MD.

As residents, we all owe at least some of our knowledge base to the teachings of Dirk M. Elston, MD. I recently sat down with Dr. Elston to find out who the man is behind the work. Our discussion was both a humbling and enlightening experience for me. This interview serves to illustrate the human side of a current pioneer within our field and also to inspire our generation of emerging leaders.

Learning from a leader: an interview with Jean L. Bolognia, MD.

Jean L. Bolognia, MD, fulfills an important role in educating dermatologists in all phases of their careers. The textbook Dermatology, for which she served as senior editor, is highly regarded as a comprehensive work covering the breadth of our field with outstanding illustrations, tables, and schematics that facilitate understanding for our visually geared specialty. When Dr. Bolognia visited the State University of New York at Stony Brook to speak at our Grand Rounds, I took the opportunity to glean valuable insights about the book as well as pearls for dermatology residents from an accomplished academic clinician.

Metabotropic glutamate receptor 1 expression and its polymorphic variants associate with breast cancer phenotypes.

Several epidemiological studies have suggested a link between melanoma and breast cancer. Metabotropic glutamate receptor 1 (GRM1), which is involved in many cellular processes including proliferation and differentiation, has been implicated in melanomagenesis, with ectopic expression of GRM1 causing malignant transformation of melanocytes. This study was undertaken to evaluate GRM1 expression and polymorphic variants in GRM1 for associations with breast cancer phenotypes. Three single nucleotide polymorphisms (SNPs) in GRM1 were evaluated for associations with breast cancer clinicopathologic variables. GRM1 expression was evaluated in human normal and cancerous breast tissue and for in vitro response to hormonal manipulation. Genotyping was performed on genomic DNA from over 1,000 breast cancer patients. Rs6923492 and rs362962 genotypes associated with age at diagnosis that was highly dependent upon the breast cancer molecular phenotype. The rs362962 TT genotype also associated with risk of estrogen receptor or progesterone receptor positive breast cancer. In vitro analysis showed increased GRM1 expression in breast cancer cells treated with estrogen or the combination of estrogen and progesterone, but reduced GRM1 expression with tamoxifen treatment. Evaluation of GRM1 expression in human breast tumor specimens demonstrated significant correlations between GRM1 staining with tissue type and molecular features. Furthermore, analysis of gene expression data from primary breast tumors showed that high GRM1 expression correlated with a shorter distant metastasis-free survival as compared to low GRM1 expression in tamoxifen-treated patients. Additionally, induced knockdown of GRM1 in an estrogen receptor positive breast cancer cell line correlated with reduced cell proliferation. Taken together, these findings suggest a functional role for GRM1 in breast cancer.

Granuloma annulare treated with excimer laser.

OBJECTIVE: To review the current therapy for granuloma annulare and report a case of refractory generalized granuloma annulare successfully treated with excimer laser. A discussion about the characteristics of excimer laser and the mechanism of its effectiveness is presented. DESIGN: Patient case report and literature review. SETTING: Outpatient dermatology practice. PARTICIPANTS: A 73-year-old woman suffering from generalized granuloma annulare for more than 40 years. MEASUREMENTS: Change in clinical appearance of lesions. RESULTS: Use of excimer laser therapy resulted in prompt and complete resolution in treated areas with no residual skin changes or side effects. CONCLUSION: Excimer laser therapy is a powerful treatment modality with minimal side effects for patients with granuloma annulare. Further study is necessary to elucidate optimal dosing, long-term efficacy, and safety profile.