Diagnosis and treatment of low-risk superficial basal cell carcinoma in a single visit.

INTRODUCTION: Surgical excision remains the most commonly utilized treatment for superficial basal cell carcinoma (sBCC). In the era of cost containment of healthcare, the rising incidence of BCC and the high cost of excision require a continuous search for efficient and cost-effective management. OBJECTIVE: Examine the feasibility of the diagnosis and treatment of low-risk sBCC in a single visit. MATERIALS AND METHODS: Retrospective chart review of sBCCs diagnosed and treated in a single visit. RESULTS: The study identified 151 histologically confirmed sBCCs in 86 patients over a 5-year period, 93 (61.6%) cases of which were diagnosed as low-risk sBCC and treated in a single appointment. The majority of the cases (n = 86) were treated with curettage alone and the rest (n = 7) with a shave removal technique. The average size of the lesion was 0.82 cm located primarily on the trunk and extremities (95.7%). One recurrence on the trunk was observed in the single appointment group. Overall, diagnostic sensitivity was 95.4% and specificity was 92.0%. CONCLUSIONS: Diagnosis and treatment of sBCC in a single visit is an efficient and cost-effective management option for those who are proficient in identifying low-risk sBCC.

Reticular Telangiectatic Erythema: A Chronic Hematoma Subsequent to Hip Replacement as an Underlying Cause.

A 78-year-old woman with a history of bilateral hip replacements presented with an ill-defined erythematous plaque with foci of reticulated and indurated areas on the left thigh. Initially, a few weeks after her surgery, a small area of erythema appeared overlying the incision site. Over a 6-month period, the erythema slowly expanded before stabilizing in size (Figure 1). There was no pruritus, pain, or warmth. Orthopedic evaluation found no evidence of infection or malfunction of the hip prosthesis. A skin biopsy revealed telangiectasia of the superficial vessels. Based on the clinical and histopathologic findings, a diagnosis of reticular telangiectatic erythema (RTE) was established. An ultrasound scan revealed a greater trochanteric bursa distended by a chronic, organized hematoma measuring 12 cm at greatest dimension, secondary to a full-thickness tear of the left gluteus minimus (Figure 2), establishing the underlying cause of the RTE in this patient.

Primary Cutaneous CD8+ T-cell Lymphoma, an Indolent and Locally Aggressive Form Mimicking Paronychia.

CD8 T-cell lymphomas comprise a wide spectrum of lymphomas, many which have yet to be formally classified. We present a case of a 43-year-old woman with an enlarging tumor distal to the distal interphalangeal joint of the fourth finger, compressing the underlying nail matrix. Magnetic resonance imaging showed bony involvement of the underlying distal phalanx. Histology showed a dense epidermotropic and pandermal infiltrate composed of medium-sized, uniformly pleomorphic lymphocytes with cleaved nuclei, which raised the possibility of primary cutaneous CD8 aggressive epidermotropic cytotoxic T-cell lymphoma. However, the patient's clinical photograph was inconsistent with this diagnosis. Other diagnoses, such as primary cutaneous acral CD8 T-cell lymphoma-a provisional entity, were also considered but did not capture all the features of this patient's lymphoma. We propose to classify this case as a primary cutaneous CD8 T-cell lymphoma, an indolent and locally aggressive form.

Necdin is a breast cancer metastasis suppressor that regulates the transcription of c-Myc.

Metastasis is the primary cause of death in breast cancer. Earlier studies using a mammary tumorigenesis mouse model identified Necdin (Ndn)as a germline modifier of metastasis. Differential expression of Ndn induces a gene-expression signature that predicts prognosis in human breast cancer. Additionally, a non-synonymous germline single nucleotide polymorphism (T50C; V17A) in Ndn distinguishes mouse strains with differing metastatic capacities. To better understand how hereditary factors influence metastasis in breast cancer, we characterized NDN-mediated transcription. Haplotype analysis in a well-characterized breast cancer cohort revealed that NDN germline variation is associated with both NDN expression levels and patient outcome. To examine the role of NDN in mammary tumor metastasis and transcriptional regulation, mouse mammary tumor cell lines stably over-expressing either the wildtype 50T or variant 50C Ndn allele were generated. Cells over-expressing Ndn 50T, but not Ndn 50C, exhibited significant decrease in cell invasiveness and pulmonary metastases compared to control cells. Transcriptome analyses identified a 71-gene expression signature that distinguishes cells over-expressing the two Ndn allelic variants. Furthermore, ChIP assays revealed c-Myc, a target gene of NDN, to be differentially regulated by the allelic variants. These data demonstrate that NDN and the T50C allele regulate gene expression and metastasis efficiency.

Treatment gain for sexual offenders against children predicts reduced recidivism: a comparative validity study.

OBJECTIVE: To determine whether pro-social treatment change in sexual offenders would predict reductions in recidivism beyond static and dynamic risk factors measured at pretreatment and whether different methods for assessing change based on self-reports and structured clinical rating systems would show convergent validity. METHOD: We compared 3 methods for assessing treatment change with a sample of adult male sexual offenders against children (n = 218) who completed a prison-based cognitive-behavioral treatment program between 1993 and 2000. The methods were measures of change derived from offender self-reports on a psychometric battery administered both pre- and posttreatment, change across treatment on the Violence Risk Scale: Sexual Offender Version (VRS:SO; Olver, Wong, Nicholaichuk, & Gordon, 2007), and posttreatment ratings on the Standard Goal Attainment Scaling for Sex Offenders (SGAS; Hogue, 1994). Offenders were followed up for an average of 12.24 years after release. RESULTS: All measures of treatment gain were positively correlated, and all significantly predicted reductions in sexual recidivism, with values for the area under the receiver-operating characteristic curve ranging from .66 (SGAS) to .70 (VRS:SO). Survival analyses showed that measures of change based on the psychometric battery significantly predicted recidivism after controlling for both static and dynamic factors measured at pretreatment, while results for the VRS:SO were similar but failed to reach significance. CONCLUSIONS: Measures of treatment change based on offender self-reports and structured clinical rating systems show convergent and predictive validity, which suggests that effective treatment that targets dynamic risk factors leads to a reduction in sexual recidivism.

Assessment of dynamic risk factors: an independent validation study of the Violence Risk Scale: Sexual Offender Version.

The Violence Risk Scale: Sexual Offender Version (VRS:SO) is a rating scale designed to assess risk among sexual offenders and the degree of change achieved in treatment. The scale consists of 7 static and 17 dynamic risk items, with protocols for measuring treatment change based on the Transtheoretical Change Model. The aim of the current study was to evaluate the psychometric properties of the VRS:SO on an independent sample of 218 child molesters who received treatment at a prison-based program in New Zealand and who were followed up for an average of 12.2 years. Supporting the initial validation of the VRS:SO, the results indicated good interrater reliability, concurrent validity, and predictive validity of the measure--VRS:SO scores were predictive of sexual recidivism (for Dynamic and Total scores, area under the curve value approximately .80), and the dynamic scale made significant incremental contributions after controlling for static risk. The authors also analyzed the validity of the factor structure of the VRS:SO dynamic scale and compared the measure with an alternative measure of dynamic risk based on a self-report psychometric battery.