ABSTRACT
A 72-year-old white man presented to the clinic with a tender, pruritic lesion on the upper part of his left arm that had progressively worsened over 4 months. Physical examination revealed an erythematous to violaceous, indurated, and sclerotic plaque with multiple foci of crusting and erosions (Figure 1). The patient denied any recent trauma, travel, fever, chills, weight loss, or constitutional symptoms. Before presentation, he had undergone treatment with cephalexin, prednisone, and doxycycline without reported improvement. Laboratory studies were negative for antinuclear antibody and SCL70 antibody; however, an absolute eosinophilia of 1478/uL was noted.
Subject(s)
Scleroderma, Localized/pathology , Aged , Arm , Blister/etiology , Humans , MaleABSTRACT
Granular parakeratosis, originally named axillary granular parakeratosis, is an uncommon disease with an unclear etiology. It is thought to result from defective processing of profillagrin to fillagrin, causing retention of keratohyaline granules in the epidermis. A myriad of causative factors has been proposed, including friction, moisture, heat, and contact irritants such as deodorants. We present a case in the inframammary area that resolved with mastopexy, further supporting the role of friction, moisture, and heat. Furthermore, we present electron microscopic evidence demonstrating non-degraded keratohyaline granules upon epidermal maturation. This entity, we believe, is reactive and represents a protective response of the body to moisture and heat.
J Drugs Dermatol. 2017;16(8):810-812.
.Subject(s)
Axilla , Parakeratosis/diagnosis , Adult , Diagnosis, Differential , Female , Humans , Parakeratosis/surgeryABSTRACT
BACKGROUND: The incidence of melanoma and nonmelanoma skin cancer continues to increase. To detect lesions at an earlier phase in their progression, skin cancer screening programs have been advocated by some. However, the effectiveness of skin cancer screening and the ideal population that these screenings should target have yet to be firmly established. This study details the relationship of a group of well-known risk factors with presumptive diagnoses in a large series of individuals self-referred for free skin cancer screening. METHODS: Data obtained during 2007 to 2010 from a descriptive cross-sectional study skin cancer screening program are presented. Participant history was recorded using standardized medical history forms prior to skin examination. Screeners conducted a skin examination varying from whole-body to limited areas (per participant preference) and recorded diagnoses. Diagnoses were assigned to the nonmelanoma cancer (NMC) or suspicious pigmented lesion group for analysis. RESULTS: A presumptive diagnosis of NMC was associated with male sex, age ≥ 50 years, personal history of skin cancer, lower skin phototype, increased sunscreen use, and increased chronic sun exposure (all P values ≤ .0001). After controlling for skin phototype, increased sunscreen use was not associated with a presumptive diagnosis of NMC (P = .96). Presumptive diagnosis of a suspicious pigmented lesion was associated with a reported history of "changing mole" (P < .0001) and negatively associated with age ≥ 50 years (P < .0001) and a personal history of skin cancer (P = .0119). CONCLUSIONS: Several known risk factors for nonmelanoma skin cancer correlated with a presumptive diagnosis of NMC. The yield of presumptive atypical pigmented lesions was increased in participants aged < 50 years, supporting the notion that this population may benefit from screening.
Subject(s)
Skin Neoplasms/diagnosis , Skin Neoplasms/prevention & control , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Cross-Sectional Studies , Early Detection of Cancer/methods , Female , Humans , Incidence , Infant , Male , Middle Aged , Risk Assessment , Risk Factors , Skin Neoplasms/pathology , Young AdultABSTRACT
BACKGROUND: Topical photodynamic therapy (PDT) is an option for the treatment of cutaneous malignancy. OBJECTIVE: To present an update and expansion on a previous review of the use of PDT in the current literature in the treatment of actinic keratoses (AK), superficial and nodular basal cell carcinoma (sBCC, nBCC), squamous cell carcinoma (SCC), Bowen's disease, cutaneous T cell lymphoma (CTCL), malignant melanoma, and its use in chemoprevention. METHODS: Extensive PubMed search January 2013. RESULTS AND CONCLUSIONS: We find sufficient evidence to recommend the use of PDT in certain patients in the treatment of AK, Bowen's disease, sBCC, and nBCC. It is especially useful in those with contraindications to surgery, widespread areas of involvement, and large lesions. Not only can it be considered superior to other therapies as far as recovery time, tolerance, and cosmetic outcomes, but it also should be considered, when indicated, as first-line treatment in the above conditions. Investigations continue for the use of PDT in the treatment of melanoma, SCC, chemoprevention, and CTCL.
Subject(s)
Photochemotherapy/methods , Skin Neoplasms/drug therapy , Bowen's Disease/drug therapy , Carcinoma, Basal Cell/drug therapy , Carcinoma, Squamous Cell/drug therapy , Humans , Keratosis/drug therapy , Lymphoma, T-Cell, Cutaneous/drug therapy , Melanoma/drug therapy , Melanoma, Cutaneous MalignantABSTRACT
Mycosis fungoides (MF) is a primary cutaneous lymphoma characterized by atypical T-lymphocytes that usually presents as patches and plaques on photoprotected areas of the body, such as the groin and buttocks. Classically, the atypical lymphocytes in MF are CD3/CD4 positive with loss of CD7 and less often loss of CD5. In a minority of cases, the atypical infiltrate is CD8 positive. We report a case of biopsy-proven MF in an elderly woman who presented with sclerodermoid lesions on her abdomen and thigh. Immunohistochemical studies revealed coexpression of CD4 and CD8 in a subset of atypical T-lymphocytes, and this was confirmed with flow cytometry. To our knowledge, this is the first report of a CD4/CD8 dual-positive MF.
Subject(s)
CD4-Positive T-Lymphocytes/pathology , CD8-Positive T-Lymphocytes/pathology , Mycosis Fungoides/pathology , Skin Neoplasms/pathology , Aged , CD4-Positive T-Lymphocytes/immunology , CD4-Positive T-Lymphocytes/metabolism , CD8-Positive T-Lymphocytes/immunology , CD8-Positive T-Lymphocytes/metabolism , Combined Modality Therapy , Female , Flow Cytometry , Humans , Immunohistochemistry , Immunophenotyping , Mycosis Fungoides/immunology , Mycosis Fungoides/therapy , Skin Neoplasms/immunology , Skin Neoplasms/therapy , Treatment OutcomeABSTRACT
Mohs micrographic surgery (MMS) has increasingly become an accepted therapy for melanoma in situ on chronically sun damaged skin (CSDS). However, melanocytes are difficult to locate in frozen material on hematoxylin and eosin. In addition, determining the cut-off between the melanoma and the "atypical melanocytic hyperplasia" in CSDS can be challenging in frozen or formalin-fixed paraffin-embedded sections, with or without immunohistochemistry (IHC). In this article, we report the use of a rapid, 35-minute protocol using microphthalmia-associated transcription factor (MITF) IHC for identifying melanocytes in frozen tissue for its potential use in MMS. In contrast to melanoma antigen recognized by T cells (MART-1), MITF is a nuclear stain, which simplifies identification of melanocytes and quantification of melanocytic parameters. In this study, MITF IHC in frozen sections yielded equivalent melanocyte nuclear diameter and density measurements compared with formalin-fixed paraffin-embedded sections. Nuclear diameter measurements obtained with MITF were similar to that previously reported with MART-1, but the melanocyte density figures were lower. Reliable labeling of melanocytes in frozen sections required the use of diaminobenzidine (DAB) chromogen with Giemsa counterstaining and a buffer devoid of surfactant. Our experience with MITF IHC indicates that it is a dependable immunostain in frozen sections, and may prove to be useful in MMS as an adjunct to hematoxylin and eosin and MART-1 IHC for interpretation of margins for melanoma in situ on CSDS.
Subject(s)
Frozen Sections , Immunohistochemistry/methods , Melanocytes/metabolism , Melanoma/diagnosis , Microphthalmia-Associated Transcription Factor/metabolism , Skin Neoplasms/diagnosis , Antigens, Neoplasm/metabolism , Biomarkers, Tumor/analysis , Humans , MART-1 Antigen , Melanoma/metabolism , Melanoma/surgery , Microphthalmia-Associated Transcription Factor/analysis , Mohs Surgery , Neoplasm Proteins/metabolism , Skin Neoplasms/metabolism , Skin Neoplasms/surgeryABSTRACT
Cardiac catheterization is a very common procedure carried out for diagnostic as well as therapeutic reasons. Complications are not surprising due to the invasive nature of the procedure. Most of these complications have been seen numerous times by cardiologists who frequent the catheterization laboratory. Unfortunately, this patient experienced an extremely rare complication that ultimately resulted in his death. Here, the authors report a case of toxic epidermal necrolysis (TEN) resulting from the nonionic radiocontrast agent used in cardiac catheterization.
Subject(s)
Cardiac Catheterization/adverse effects , Contrast Media/adverse effects , Stevens-Johnson Syndrome/etiology , Fatal Outcome , Humans , Male , Middle AgedABSTRACT
The authors report a case of a Latin American woman who developed progressive pigmentation primarily involving two digits of her right hand. She was scheduled for amputation based on a presumptive histologic diagnosis of melanoma with regression. Dermatology consultation with repeat biopsies disclosed a lichenoid tissue reaction with marked pigment incontinence and no evidence of melanoma. This report should prompt physicians to include lichen planus pigmentosus in the differential diagnosis of acral lentiginous melanoma.
Subject(s)
Hyperpigmentation/diagnosis , Lichen Planus/diagnosis , Melanoma/diagnosis , Skin Neoplasms/diagnosis , Diagnosis, Differential , Erythema/diagnosis , Female , Humans , Hyperpigmentation/pathology , Lichen Planus/pathology , Melanoma/pathology , Middle Aged , Skin Neoplasms/pathologyABSTRACT
Pityriasis rubra pilaris (PRP) is an uncommon dermatosis of unknown etiology. The familial subtype is rare and usually presents as type V PRP. It is generally inherited in an autosomal dominant fashion with variable expression. Other forms of inheritance, such as autosomal recessive and X-linked, have also been reported. The use of etanercept in treating resistant forms of PRP is promising given reports of its success in a few cases. Herein, the authors report two cases of PRP arising in a mother and son and review the rare familial subtype of this disease. In addition, a successful therapeutic trial of etanercept was initiated in the mother based on case reports of its efficacy in other patients with PRP.
Subject(s)
Immunoglobulin G/therapeutic use , Pityriasis Rubra Pilaris/drug therapy , Pityriasis Rubra Pilaris/genetics , Receptors, Tumor Necrosis Factor/therapeutic use , Tumor Necrosis Factor-alpha/antagonists & inhibitors , Adolescent , Diagnosis, Differential , Etanercept , Female , Humans , Male , Middle Aged , Pityriasis Rubra Pilaris/pathologyABSTRACT
Merkel cell carcinoma (MCC) is a highly aggressive neoplasm affecting primarily the elderly Caucasian population. Earlier detection of this neoplasm may achieve a better prognosis and an improved outcome. Here, the authors review the typical clinical features of MCC to serve as a reference tool for clinicians in determining when a biopsy may be warranted. An array of immunohistochemical markers may be utilized to differentiate MCC from other neuroendocrine tumors. The staging and concomitant treatment options of MCC are discussed. In addition, the authors review therapeutic advances for treatment of MCC utilizing an array of target proteins.
Subject(s)
Carcinoma, Merkel Cell/therapy , Skin Neoplasms/therapy , Carcinoma, Merkel Cell/mortality , Carcinoma, Merkel Cell/pathology , Humans , Neoplasm Staging , Prognosis , Skin Neoplasms/mortality , Skin Neoplasms/pathologyABSTRACT
Cutaneous T-cell lymphoma (CTCL) is a type of non-Hodgkin's lymphoma characterized by the malignant proliferation of T lymphocytes in the skin. Phototherapy has been proven an effective treatment modality for CTCL, in particular early stage disease (patch and plaque). Specifically, broadband ultraviolet B (BB-UVB), psoralen and ultraviolet A (PUVA), and more recently narrowband UVB (NB-UVB) are the skin-directed phototherapies typically utilized. Phototherapy poses the risk of sunburn, photoaging and photocarcinogenesis. Combination therapies with IFN-alpha, retinoids (acitretin and isotretinoin) and rexinoid (bexarotene) are adjunctive systemic therapies that facilitate enhanced therapeutic response and often allow for lower doses of phototherapy. Extracorporeal photopheresis (ECP) has also been shown to be effective in more advanced stage disease.
Subject(s)
Lymphoma, T-Cell, Cutaneous/therapy , Phototherapy/methods , Skin Neoplasms/therapy , Humans , PUVA Therapy , Photopheresis , Ultraviolet TherapyABSTRACT
Angioimmunoblastic T-cell lymphoma (AITL) is a systemic lymphoproliferative disease characterized by a polymorphous neoplastic infiltrate involving lymph nodes as well as extranodal locations, including the skin. Cutaneous involvement is seen in approximately 50 percent of cases and is usually secondary to systemic disease. Patients with cutaneous involvement classically present with a transient morbilliform eruption of the trunk; however, papules, nodules, urticarial plaques and erythroderma have also been reported. In contrast, primary cutaneous AITL is exceedingly rare. The authors report a case of a 79-year-old woman with AITL who presented with primary cutaneous tumors and ulcerated nodules, with no evidence of systemic involvement, hypergammaglobinemia, or B symptoms. Histologically, a subtle lymphoid infiltrate was present, dominated by marked fibrosis and a diffuse infiltrate of neutrophils, eosinophils and plasma cells, mimicking an inflammatory or infectious etiology. This presentation presents a unique diagnostic challenge; careful investigation and strong clinical suspicion must be utilized in order to correctly identify AITL in this setting.
Subject(s)
Dermatitis/pathology , Immunoblastic Lymphadenopathy/pathology , Lymphoma, T-Cell, Cutaneous/pathology , Skin Neoplasms/pathology , Aged , Dermatitis/diagnosis , Diagnosis, Differential , Female , Humans , Immunoblastic Lymphadenopathy/diagnosis , Lymphoma, T-Cell, Cutaneous/diagnosis , Skin Neoplasms/diagnosisABSTRACT
Cutaneous polyarteritis nodosa (CPAN) is a rare cutaneous small- to medium-vessel vasculitis of unknown etiology. Clinically it ranges in manifestation from livedo reticularis to large cutaneous ulcers and necrosis. Prognosis is favorable and progression to systemic polyarteritis nodosa is rare. There are multiple treatment options, none of which have proven to be definitively effective. Cutaneous polyarteritis nodosa has been associated with abnormal antibody testing with elevations of antiphospholipid cofactor antibody, lupus anticoagulant, anticardiolipin antibody, and anti-ß2-glycoprotein I-dependent cardiolipin antibodies, as well as elevated anti-phosphatidylserine-prothrombin complex antibody. These antibodies suggest increased risk for thrombosis and systemic diseases such as lupus or other autoimmune connective tissue disease. We present a case of asymptomatic CPAN and evaluate if treatment should be instituted for asymptomatic disease that presents with abnormal antibody findings.
Subject(s)
Antibodies, Antiphospholipid/immunology , Polyarteritis Nodosa/therapy , Practice Guidelines as Topic , Aged , Female , Humans , Polyarteritis Nodosa/immunology , Risk , Skin/immunology , Skin/pathology , Thrombosis/etiologyABSTRACT
Patients with a history of more than four basal cell carcinomas (BCCs) or squamous cell carcinomas (SCCs) are at high risk for developing further skin cancers. Immunosuppressed patients, especially solid organ transplantation patients, harbor a higher risk of developing SCC. Systemic retinoids have been demonstrated to possess chemoprophylactic properties in the treatment of non-melanoma skin cancer. This article reviews the efficacies of the available oral retinoid agents in the chemoprophylaxis of SCCs in high-risk solid organ transplant recipients.
Subject(s)
Carcinoma, Basal Cell/drug therapy , Carcinoma, Basal Cell/prevention & control , Retinoids/therapeutic use , Skin Neoplasms/drug therapy , Skin Neoplasms/prevention & control , Transplantation , Animals , Carcinoma, Basal Cell/pathology , Chemoprevention/methods , Double-Blind Method , Humans , Randomized Controlled Trials as Topic , Risk Factors , Skin Neoplasms/pathologyABSTRACT
Reticular erythematous mucinosis (REM) is a rare cutaneous condition often referred to as plaque-like mucinosis and midline mucinosis. Although the exact etiology remains undefined, efforts to elucidate pathogenesis, disease associations, and prospective treatment modalities have been encouraging. Induction of the disease has been associated with viral processes, solar irradiation, specific cell lines, and cytokines such as Interleukin (IL)-1ß. Clinically, patients typically develop erythematous macules and papules that coalesce into reticulated patterns on the midline of the chest or back. The lesions have a tendency to respond to systemic antimalarial therapy, but novel therapeutic approaches with ultraviolet A1 light (UVA1) and pulse dye laser (PDL) have been promising. Histologically, REM is associated with a mild, predominantly lymphocytic infiltrate with variable deep perivascular extension. Mucin may be seen in the upper and mid dermis and is prominent around the infiltrate and appendages. IgM deposits may be visualized under direct immunoflourescence along the basal layer. Because of the similarities between REM and tumid lupus, the two disease processes have often been grouped together. The remarkable overlap between the two diseases suggests that the two conditions may actually be the same disease.
Subject(s)
Mucinoses/diagnosis , Antimalarials/therapeutic use , Chronic Disease , Dermatologic Agents/therapeutic use , Female , Humans , Immunoglobulin M/analysis , Lupus Erythematosus, Systemic/diagnosis , Male , Mucinoses/drug therapy , Mucinoses/pathology , Mucinoses/radiotherapy , Mucins/analysis , Ultraviolet TherapyABSTRACT
Basal cell carcinoma (BCC) remains the most common form of nonmelanoma skin cancer (NMSC) in Caucasians, with perhaps as many as 2 million new cases expected to occur in the United States in 2010. Many treatment options, including surgical interventions and nonsurgical alternatives, have been utilized to treat BCC. In this paper, two non-surgical options, imiquimod therapy and photodynamic therapy (PDT), will be discussed. Both modalities have demonstrated acceptable disease control rates, cosmetically superior outcomes, and short-term cost-effectiveness. Further studies evaluating long-term cure rates and long-term cost effectiveness of imiquimod therapy and PDT are needed.
ABSTRACT
Skin changes associated with alcohol and drug abuse can be the earliest clinical manifestation of these disorders. The signs associated with these conditions may be distinctive and easily recognizable. Alcohol abuse can present with jaundice, pruritus, hyperpigmentation, and urticaria. Commonly associated vascular changes include spider telangiectasias, angiomas, caput medusas, flushing, and palmar erythema. Disease states related to alcohol abuse include psoriasis, porphyria cutanea tarda, and nutritional deficiencies. Alcohol abuse may predispose to the development of carcinomas of the skin, oropharynx, liver, pancreas, and breast. Cutaneous signs of drug abuse include skin granulomas, ulcerations, and recurrent infections. Specifically, oral disease and tooth decay are examples of stigmata often associated with methamphetamine abuse, a popular and inexpensive drug now on the scene. By being cognizant of these cutaneous markers of alcohol and drug abuse, dermatologists are often in the unique position of being able to recognize these changes, prompting early diagnosis and intervention, hopefully resulting in a better clinical outcome for these troubled patients and their families.