Merkel Cell Carcinoma: A Bibliometric Analysis of the Top 100 Cited Publications.

BACKGROUND: Bibliometric studies provide a quantitative statistical analysis of the published literature within a field of interest and allow for easy identification of the major contributing authors, funding sources, and publication trends within the field. To date, no bibliometric studies have been performed pertaining to Merkel cell carcinoma (MCC). OBJECTIVE: To identify the 100 most frequently cited articles in MCC through a bibliometric analysis of the literature. METHODS: Web of science was queried to determine the 100 most frequently cited MCC publications published between the years 1970 and 2019. Articles were listed by title, authors and their affiliated institutions, journal title and type, year of publication, country of origin, funding sources, and citation frequency. RESULTS: Among the 100 most frequently cited MCC publications, articles were cited between 67 and 589 times with a mean of 136.3 times. Articles were cited between 2.0 and 98.2 times per year since publication with a mean of 11.3 times per year. 67% of the articles were published in oncology journals; 33% and 10% of the articles in dermatology and surgery journals, respectively. The most represented journal was Cancer (12%). Paul Nghiem was the most frequently identified author (18%). 36% of the top 100 articles were published out of the University of Washington. The most frequent funding agency was the National Institutes of Health (77%). CONCLUSION: Through this bibliometric analysis, researchers can easily identify key publications pertaining to MCC, which may in turn enhance their approach to understanding and practicing evidence-based medicine regarding MCC.

Ecthyma gangrenosum: The critical role of biofilms and other mechanisms of antibiotic resistance and implications for management.

Ecthyma gangrenosum is a rare cutaneous infection that occurs classically in immunocompromised patients with Pseudomonas aeruginosa bacteremia and is associated with a high mortality rate. Causative pathogens may exhibit various antibiotic evasion mechanisms, and thus, treatment may be challenging. We present a case of ecthyma gangrenosum in association with an implantable port in which cultures confirmed ten unique strains of Pseudomonas aeruginosa, highlighting the ability of this pathogen to form biofilms, rapidly mutate and ultimately evade antibiotic therapy. Dermatologists play a key role in the prompt diagnosis of this life-threatening condition, and a thorough understanding of pathogenic mechanisms is critical in selecting an efficacious treatment regimen.

Adenodermatofibroma: a rare variant.

Adenodermatofibroma is a newly recognized variant of fibrous histiocytoma (dermatofibroma), a benign lesion frequently encountered in dermatologic practice. There are many established variants of fibrous histiocytoma but there are only eight reported cases of this specific variant in the literature. This report reviews a case of an adenodermatofibroma presenting as a large, firm, atrophic plaque on the thigh. Histopathologic findings showed dilated glandular structures with apocrine features within a fibrohistiocytic cellular infiltrate, consistent with the diagnosis. We review the characteristic findings of adenodermatofibroma, discuss the differential diagnosis, and examine current theories speculating the origin of apocrine glands present within these lesions.

Cutaneous refractile foreign body microemboli with intravascular injection of oral medication.

Injection drug abuse (IDA) is known to cause a spectrum of systemic and cutaneous complications. Despite the increasing incidence of IDA around the world, there is a paucity of literature discussing cutaneous complications from a dermatopathologic perspective. We present a case of a 35-year-old male with a complex medical history of Von Willebrand disease, Beçhet disease and diverticular disease. Following a sigmoidectomy/colostomy for diverticular perforation, he presented with fever and an indurated right arm displaying livedoid purpura. The right distal fingertips showed purpura with focal ulceration. A punch biopsy of the right wrist did not show evidence of inflammatory vasculitis or pyogenic infection, but instead showed a focus of polarizing, refractile material occluding a dilated arterial lumen within the mid-dermis. The patient admitted to injecting a suspension of crushed ondansetron (Zofran) tablets into the antecubital area to control post-operative nausea. It is known that direct intravascular injection of foreign material can cause distal ischemia and necrosis, either by local vasoconstriction, thrombosis, or formation of microemboli, as in this patient. Our objective is to bring awareness to this rarely reported phenomenon, and to raise clinical suspicion for IDA when confronted with such a unique vasculopathic pattern.

Educational Gaps in Molecular Diagnostics, Genomics, and Personalized Medicine in Dermatopathology Training: A Survey of U.S. Dermatopathology Fellowship Program Directors.

BACKGROUND: Molecular technologies offer clinicians the tools to provide high-quality, cost-effective patient care. We evaluated education focused on molecular diagnostics, genomics, and personalized medicine in dermatopathology fellowship training. DESIGN: A 20-question online survey was emailed to all (n = 53) Accreditation Council for Graduate Medical Education (ACGME)-accredited dermatopathology training programs in the United States. RESULTS: Thirty-one of 53 program directors responded (response rate = 58%). Molecular training is undertaken in 74% of responding dermatopathology fellowships, with levels of instruction varying among dermatology-based and pathology-based programs. Education differed for dermatology- and pathology-trained fellows in approximately one-fifth (19%) of programs. Almost half (48%) of responding program directors believe that fellows are not currently receiving adequate molecular education, although the majority (97%) expect to incorporate additional instruction in the next 2-5 years. Factors influencing the incorporation of relevant education include perceived clinical utility and Accreditation Council for Graduate Medical Education/residency review committee (RRC) requirements. Potential benefits of molecular education include increased medical knowledge, improved patient care, and promotion of effective communication with other healthcare professionals. More than two-thirds (68%) of responding program directors believe that instruction in molecular technologies should be required in dermatopathology fellowship training. CONCLUSIONS: Although all responding dermatopathology fellowship program directors agreed that molecular education is important, only a little over half of survey participants believe that their fellows receive adequate instruction. This represents an important educational gap. Discussion among those who oversee fellow education is necessary to best integrate and evaluate teaching of molecular dermatopathology.

Immunomodulators for Non-Melanoma Skin Cancers: Updated Perspectives.

Non-melanoma skin cancers (NMSCs) are the most common cancers worldwide and may be associated with significant morbidity and mortality, especially in immunosuppressed populations. Successful management of NMSC must take primary, secondary and tertiary prevention strategies into consideration. In response to an improved understanding of the pathophysiology of NMSC and associated risk factors, multiple systemic and topical immunomodulatory drugs have been developed and integrated into clinical practice. Many of these drugs are efficacious in the prevention and treatment of precursor lesions (actinic keratoses; AKs), low-risk NMSC, and advanced disease. The identification of patients at high risk for the development of NMSC is critical in reducing disease morbidity. Understanding the various treatment options available and their comparative effectiveness is paramount for developing a personalized treatment regimen for such patients. This review article provides an updated overview of the various topical and systemic immunomodulatory drugs available for the prevention and treatment of NMSC, and the published data supporting their use in clinical practice.

Skin Metastasis of Low-Grade Ovarian Serous Carcinoma: A Case Report.

This case report, written with the assistance of ChatGPT, describes a rare manifestation of ovarian serous carcinoma that metastasized to the skin. A 30-year-old female with a history of stage IV low-grade serous ovarian carcinoma presented for evaluation of a painful nodule on her back. Physical examination demonstrated a round, firm, mobile subcutaneous nodule on the left upper back. An excisional biopsy was performed, and histopathologic examination was consistent with metastatic ovarian serous carcinoma. This case highlights the clinical presentation, histopathology, and treatment of cutaneous metastasis of serous ovarian carcinoma. Additionally, this case highlights the value and technique of using ChatGPT to assist in writing medical case reports including outlining, referencing, summarizing studies, and formatting citations.

iPS-derived neural progenitor cells from PPMS patients reveal defect in myelin injury response.

Primary progressive multiple sclerosis (PPMS) is a chronic demyelinating disease of the central nervous system (CNS) currently lacking any effective treatment. Promoting endogenous brain repair offers a potential strategy to halt and possibly restore neurologic function in PPMS. To understand how the microenvironment within white matter lesions plays a role in repair we have focused on neural progenitor cells (NPCs) since these are found in lesions in PPMS and have been found to influence oligodendrocyte progenitor cell maturation (OPCs). To better understand the cellular nature of NPCs in PPMS we developed iPS cells from blood samples of PPMS patients and age matched non-disease spouse or blood relative controls. Using these iPS cell lines we determined that the NPCs from PPMS cases provided no neuroprotection against active CNS demyelination compared to NPCs from control iPS lines which were capable of completely preventing injury. Conditioned media (CM) from PPMS NPCs provides no protection to OPCs and prevents maturation of OPCs into oligodendrocytes in vitro. We also found that CM from PPMS iPS NPCs elicited patient-specific differences in the response to compounds that should foster oligodendrocyte (OL) maturation. Together, these data establish a new model for understanding the nature of myelination defects in PPMS which may lead to novel targeted approaches for preventing demyelination in these patients.