Intraneural Melanoma Identified With MART-1 Immunostaining in Mohs Micrographic Surgery.

Mohs micrographic surgery (MMS) utilizing melanoma antigen recognized by T-cells (MART-1) immunostaining is an increasingly common method of treatment for minimally invasive melanoma in anatomically constrained areas such as the face, ears, or acral sites. Neurotropic melanoma, also known as neurotrophism in melanoma, refers to the invasion of melanoma cells into the nerves. As such, these tumors can extend well beyond anticipated clinical tumor margins which can increase the risk of local recurrence. Here, we present a case of neurotropic melanoma successfully identified during MMS using MART-1 immunostaining, which was then confirmed with permanent sectioning.

Dermatopathology Laboratory Green Initiatives.

OBJECTIVES: Climate change and the accumulation of greenhouse gases pose challenges for humanity. The laboratory can reduce the environmental impact of routine operations. METHODS: Our laboratory implemented several recycling initiatives in 2021, including shredding plastic and recycling 10% formalin, xylene, and reagent alcohols. Additional insulation has reduced electricity costs, and we have plans to derive 100% of our electricity from solar in 2022. RESULTS: Recycling leads to decreases in reagent purchase by several hundred gallons. Our lab reduced its carbon footprint by a minimum of 68.52 tons, with an anticipated $43,000 savings in purchases and waste disposal during 2022. CONCLUSIONS: Regardless of an individual's environmental consciousness, green initiatives have several tangible benefits. Recycling helps mitigate climate change and decrease the laboratory's carbon footprint. These measures also insulate the laboratory from supply shortages and lead to significant, tangible monetary savings.

Granuloma Annulare Mimicking Squamous Cell Carcinoma.

Misdiagnosing granuloma annulare (GA) for a malignant process can lead to unnecessary and costly treatment avenues for the patient. Thus, it is salient for surgeons to independently evaluate a patient's clinical and histopathologic presentation before proceeding with surgery. We present a case of a 67-year-old male with a biopsy-proven squamous cell carcinoma (SCC) on the dorsal hand who presented for Mohs micrographic surgery (MMS). At this time, the surgeon noticed the histopathologic diagnosis did not match the patient's clinical appearance. GA was diagnosed following a repeat biopsy of the lesion, which prevented an unnecessary Mohs procedure. We present this case primarily to highlight the importance of clinicopathologic correlation by the surgeon when a patient is referred for surgery.

Topical nitroglycerin: a promising treatment option for chondrodermatitis nodularis helicis.

BACKGROUND: Chondrodermatitis nodularis helicis (CNH) is a painful nodule that often interferes with sleep and occurs on the helix or antihelix of the ear in older patients. Although several case reports describe a variety of seemingly effective surgical and conservative treatment options, well-studied treatment modalities have varying efficacy rates and can often demonstrate disappointing results. OBJECTIVES: The purpose of this study was to evaluate the efficacy of 2% topical nitroglycerin for the treatment of CNH. METHODS: A retrospective chart review was performed in 12 patients given the diagnosis of CNH who received 2% topical nitroglycerin twice daily for therapy. Therapeutic efficacy was determined by identifying improvement in the appearance and symptomatology of the lesion. RESULTS: A total of 13 lesions in 12 patients were treated, with 12 (92%) lesions demonstrating improvement with the use of topical nitroglycerin. Eight of 13 (61.5%) CNH lesions developed complete clearance and resolution of symptoms, requiring no further treatment. Four of 13 (30.8%) lesions were found to have only symptomatic improvement, and these patients continued to use the ointment as needed. One of 12 (8.3%) patients found no benefit with the treatment but had also failed multiple other treatments modalities. LIMITATIONS: Limitations include the small number of patients treated and the retrospective nature of the study. CONCLUSIONS: Topical nitroglycerin demonstrated efficacy in treating both the symptoms and lesional appearance of CNH in a noninvasive manner, with an overall success rate that is comparable with other published methods.

Progression from atypical/dysplastic intraepidermal proliferations and carcinoma in situ to invasive tumors: a pathway based on current knowledge.

Oncology research efforts in recent years have begun to elucidate the role of the peritumoral stroma in the development of dysplasia and subsequent invasive malignancy. In the skin, the stroma surrounding keratinocytic and melanocytic tumors reacts to the dysplastic epidermis in a similar fashion to the wound healing response. Once epidermal genetic mutations and aberrant molecular signaling have occurred, the stroma responds through a 3-phase process-extracellular matrix degradation is produced by matrix metalloproteinases; angiogenesis is induced by vascular endothelial growth factor and mast cell mediators; and the inflammatory response is elicited by cytokines and cyclin D1 overexpression balanced by the immunosuppression of mast cell mediators such as tumor necrosis factor alpha, histamine, and transforming growth factor beta. By reacting like injured dermis, the actions of various stromal mediators directly allow for, and even encourage, the progression of in situ atypia/dysplasia to invasive malignancy. The intent of this article is to review the multistep biological and chemical stromal processes, which are involved in the progression of atypical/dysplastic intraepidermal proliferations to invasive malignancy.

Nodular mucinosis of the breast: expanding our understanding with an unusual case.

Nodular mucinosis of the breast is an extraordinarily rare lesion that occurs in patients who do not have Carney syndrome. Typically, the affected patients are young women with no medical history and a nodule under 1 nipple. Histopathologic examination has, until now, shown a multinodular myxoid lesion containing scattered capillaries and histiocytes but void of epithelial components. We present the case of a 72-year-old woman with a history of mucinous carcinoma of the breast who now presents with a painful subareolar nodule of the same breast. Biopsy and histological examination confirmed nodular mucinosis of the breast.

TTF-1 and napsin A do not differentiate metastatic lung adenocarcinomas from primary esophageal adenocarcinomas: proposal of a novel staining panel.

CONTEXT: When adenocarcinomas arise within the esophagus, particularly when located away from the gastroesophageal junction, it may be important in some patients to differentiate between a primary esophageal adenocarcinoma and metastasis from another site. Lung adenocarcinoma is one tumor that has been reported to frequently metastasize to the esophagus. OBJECTIVES: To create a panel of immunohistochemical markers that can reliably distinguish between an esophageal and pulmonary primary; within the gastrointestinal pathology literature, including published articles and textbooks, common lung immunohistochemical markers, such as TTF-1, are assumed to be negative in esophageal adenocarcinoma, yet, to our knowledge, no study has yet investigated the veracity of that presumption. DESIGN: In this study, 24 cases each of pulmonary and esophageal adenocarcinomas were stained with TTF-1, napsin A, CDX2, 34ßE12, N-cadherin, and IMP3 in an attempt to define an optimal panel for differentiation. Esophageal adenocarcinomas occurring at the gastroesophageal junction were excluded in this study because a gastric primary tumor cannot be excluded in those cases. RESULTS: Surprisingly, TTF-1 and napsin A were positive in similar proportions of tumors from both sites. Those markers that differentiated statistically between esophageal and pulmonary adenocarcinoma were IMP3, CDX2, and N-cadherin. CONCLUSIONS: When differentiating the origin of a tumor as either esophageal or pulmonary, an immunohistochemical panel consisting of IMP3, CDX2, and N-cadherin is superior to either TTF-1 or napsin A.

Cutaneous infections caused by Herpesviridae: a review.

The herpes family of viruses accounts for a significant proportion of human cutaneous disease. Although most episodes of viral infection can be diagnosed clinically, a small subset of these outbreaks will require biopsy for histologic interpretation and diagnosis. Most herpesviruses cause characteristic architectural and cytologic changes in the context of active infection, whereas the effects of some will not manifest until the future as malignant disease. Other infections may go unnoticed secondary to a lack of specific histologic findings. Because herpesviruses cause such a wide spectrum of cutaneous conditions, it is prudent that pathologists be aware of the varied clinical and histopathologic presentations so that these infections will not persist undiagnosed. Additionally, methods of virus detection will briefly be reviewed.

Functions and uses of immunohistochemical stains in cutaneous infiltrates of hematopoietic origin: a review for the practicing dermatologist.

BACKGROUND: Immunohistochemical stains, particularly those for cutaneous lymphomas, have similar-sounding names, which may lead to confusion among dermatologists who are not well versed in the terminology of the tools used for pathologic diagnosis. Also aiding in this is the fact that some familiar stains are constantly investigated for novel utility in different tumors, and a plethora of new stains regularly emerge in the peer-reviewed literature. OBJECTIVE: To review the major stains encountered in dermatopathologic reports for cutaneous lymphomas. A select number of other stains are reviewed that are either new and under investigation in several cutaneous processes or have a new use described in recent reports. METHODS: The peer-reviewed literature was searched and analyzed for the accepted purposes of using these markers. RESULTS: All pertinent findings for these immunostains are reported with the purpose of educating the dermatology community. CONCLUSION: This review serves as a reference to clarify potentially confusing immunohistochemical stains.

Nausea and vomiting after placement of tension-free vaginal tape sling.

BACKGROUND: Minimally invasive surgical procedures such as tension-free vaginal tape sling should not imply that a minimal preoperative evaluation is all that is required. CASE: A 52-year-old multiparous perimenopausal woman presented with postoperative nausea, vomiting, and vague abdominal-pelvic discomfort after placement of tension-free vaginal tape. The final diagnosis was invasive molar pregnancy. CONCLUSION: This case raises the awareness of the rare diagnosis of gestational trophoblastic disease in perimenopausal women and emphasizes the importance of a complete preoperative evaluation in those scheduled to undergo minimally invasive procedures.

Unusual and recently described cutaneous atrophic disorders.

Cutaneous atrophic conditions are typically caused by changes in the dermis or subcutaneous tissue, sometimes consisting of the loss of a single fiber type. Since a significant decrease of subepidermal tissue is necessary for these lesions to be macroscopically atrophic, many conditions may not be appreciated as atrophy in the clinical setting. Clinicians should be familiar with the common or classic disorders causing cutaneous atrophy; however, there are a few new or rarely described atrophic conditions which are more difficult to identify and may not be atrophic clinically. This paper serves to describe the salient clinical and histological features of these new or rare disorders.