Mohs for Melanoma: A Review of MART-1 Frozen Section Interpretation.

BACKGROUND: Mohs surgery for melanoma has been performed for many decades, but advances in the use of immunohistochemistry with frozen sections during Mohs surgery have allowed for more accurate, reliable, and efficient margin assessment with improved local control of the disease. OBJECTIVE: To describe the use of MART-1 in treating melanoma with Mohs surgery and serve as a primer for the Mohs surgeon adding melanoma cases to their repertoire. MATERIALS AND METHODS: Review of the literature and discussion of experience with Mohs for melanoma. RESULTS: Practical approach and pitfalls when assessing margins using MART-1 immunohistochemistry during Mohs surgery for the treatment of melanoma. CONCLUSION: Mohs for melanoma is an expanding field-education of Mohs surgeons and increasing the practice of this technique has the potential to improve patient outcomes.

Ethosuximide-induced drug reaction with eosinophilia and systemic symptoms with mediastinal lymphadenopathy.

Lymphadenopathy is a common sign for drug reaction and eosinophilia with systemic symptoms (DRESS) syndrome, but hilar and mediastinal lymphadenopathy may be underreported. We describe a 7-year-old boy who started taking ethosuximide for absence seizures and presented with diffuse rash, fever, elevated transaminases, facial swelling, and hilar and mediastinal lymphadenopathy. His mediastinal lymphadenopathy was concerning for lymphoma, which led to more invasive testing to rule out malignancy. This report highlights an unusual and likely underreported presenting sign of DRESS syndrome in children.

Angioimmunoblastic T-cell Lymphoma Mimicking DRESS Syndrome.

Angioimmunoblastic T-cell lymphoma (AITL) is a rare and aggressive lymphoma arising from follicular T-helper cells. Cutaneous findings and nonspecific systemic symptoms often associated with this malignancy can closely resemble those of more common entities, such as a viral exanthem or drug eruption, depending on the history and context. These similarities in presentation to more common entities can cause a delay in the diagnosis of AITL and subsequent initiation of treatment, which has considerable implications for morbidity and mortality. We present the case of a patient whose clinical features resembled drug reaction with eosinophilia and systemic symptoms (DRESS syndrome) and who was found to have AITL after extensive workup. This atypical case highlights the importance of maintaining a flexible differential diagnosis in patients with suspected DRESS syndrome whose condition does not improve with appropriate drug withdrawal and therapy.

Jet Fuel-Associated Occupational Contact Dermatitis.

INTRODUCTION: Occupational contact dermatitis is a ubiquitous problem. Sailors onboard U.S. Navy vessels are at high risk given the multitude of potential workplace exposures. Solvents, petrochemicals, and fuels are abundant and can cause irritant or allergic contact dermatitis. Symptoms of contact dermatitis can cause inability to work and, if chronic, may require a change in rating or job. Prevention of this issue requires patient education about the risks and correct personnel protective equipment. Even with preventative strategies in place, exposures and cases of contact dermatitis will occur. Treatment consists of topical steroids and immunomodulators, as well as barrier creams and emollients. The goal of treatment is to fully restore the skin's natural barrier and prevent further exposure. MATERIALS AND METHODS: A classic case of jet fuel-associated contact dermatitis is reviewed. A literature review utilizing PubMed, Google Scholar, and Google Search was conducted to elucidate our understanding of this issue, current occupational health guidelines, preventative approaches, and treatments. RESULTS: This case report provides guidance and recommendations for providers who encounter contact dermatitis related to petrochemicals, such as jet fuel. The literature review revealed limited knowledge surrounding in vivo human skin effects of jet fuel, specifically JP-5. Even larger gaps were found in our understanding of, and guidelines for, protective modalities against jet fuel exposure and dermatitis. CONCLUSION: A case is presented to facilitate recognition of jet fuel contact dermatitis and guidance for treatment and prevention. Given our current limited knowledge and guidelines concerning protective equipment and skin protectants, multiple proposals for future studies are suggested.

Bullous systemic lupus erythematosus: a review and update to diagnosis and treatment.

Bullous systemic lupus erythematosus (BSLE) is a rare cutaneous complication of systemic lupus erythematosus (SLE). It is a heterogeneous disease that is caused by autoantibodies to the dermoepidermal junction, mainly type VII collagen. Similarities in histology and immunopathology exist between BSLE and other primary bullous dermatoses, namely dermatitis herpetiformis (DH) and epidermolysis bullosa acquisita (EBA), respectively. EBA and BSLE commonly share the same autoantibody to type VII collagen and heterogeneous clinical presentations, creating a diagnostic challenge. However, clinical presentation combined with histology, immunological testing, and concomitant diagnosis of SLE distinguish this entity from other similar dermatoses. Diagnosis of this disease is important given its coexistence with SLE and its many complications. New developments in IgG subtyping have shown subtle variations in IgG subtypes between EBA and BSLE. In addition, rituximab was recently found to be efficacious in recalcitrant cases of BSLE that do not respond to dapsone and immunosuppressants. We review the topic of BSLE with emphasis on clinical, histologic, and immunopathologic features, as well as new methods of diagnosis and treatment.