Subject(s)
Biopsy/methods , Carcinoma, Squamous Cell/pathology , Skin Neoplasms/pathology , Skin/pathology , Aged , Carcinoma, Basal Cell/pathology , Diagnosis, Differential , Female , Head and Neck Neoplasms/pathology , Humans , Male , Practice Guidelines as Topic , Retrospective Studies , Upper ExtremityABSTRACT
BACKGROUND: The scalp is a target for squamous cell carcinoma (SCC) in male organ transplant recipients (OTRs) with alopecia. These tumors can behave aggressively and are associated with high recurrence, morbidity, and mortality. Treatment guidelines are needed for SCC in the scalp of OTRs. OBJECTIVE: To explore the clinical and histologic features associated with SCC recurrence and aggressiveness in the scalp of OTRs. We review the mechanisms involved as they relate to a case. An algorithm for evaluation and treatment is introduced. METHODS: An OTR presented with poorly differentiated SCC of the scalp that recurred on three occasions after Mohs micrographic surgery (MMS). The final recurrence invaded the bone and cranial cavity. We discuss the difficulties encountered in evaluating and treating these patients. RESULTS: This patient had multiple factors associated with high tumor recurrence and aggressiveness. These were explored, and an algorithm was created. CONCLUSION: SCC in the scalp of OTRs presents challenges for evaluation and management. We must be vigilant to monitor for recurrence, perineural invasion, bone invasion, multiple-field tumors, and metastasis. An understanding of the mechanisms of tumor recurrence will assist us in preventing morbidity and mortality in this subset of patients.
Subject(s)
Carcinoma, Squamous Cell/pathology , Carcinoma, Squamous Cell/surgery , Kidney Transplantation/adverse effects , Neoplasm Recurrence, Local/pathology , Neoplasm Recurrence, Local/surgery , Pancreas Transplantation/adverse effects , Skin Neoplasms/pathology , Skin Neoplasms/surgery , Adult , Carcinoma, Squamous Cell/etiology , Head and Neck Neoplasms/etiology , Head and Neck Neoplasms/pathology , Head and Neck Neoplasms/surgery , Humans , Male , Mohs Surgery , Neoplasm Invasiveness/pathology , Neoplasm Staging , Practice Guidelines as Topic , Scalp/pathology , Skin Neoplasms/etiologyABSTRACT
Microcystic adnexal carcinoma (MAC) is a rare cutaneous neoplasm that is often diagnosed after having been present for a significant period of time. It appears bland on histologic evaluation despite its locally aggressive behavior. Actual skin involvement is significantly more extensive than can be determined clinically and because of this, therapy is challenging. Though metastasis is rare, there have been reports of both regional and distant metastatic disease. Several treatment modalities have been used to date, including standard excision (SE), Mohs micrographic surgery (MMS), irradiation, chemotherapy, and observation. There has also been discussion in the literature regarding techniques than can aid in assurance of clear margins with MMS. We review the literature on MAC, including the various therapeutic options, addressing when one modality may be preferable over others. In general, MMS offers the highest likelihood of clear margins and cure with the fewest procedures.
Subject(s)
Carcinoma, Skin Appendage/therapy , Skin Neoplasms/therapy , Carcinoma, Skin Appendage/diagnosis , Carcinoma, Skin Appendage/pathology , Humans , Mohs Surgery , Neoplasm Metastasis/pathology , Neoplasm Recurrence, Local , Skin Neoplasms/diagnosis , Skin Neoplasms/pathology , Time FactorsABSTRACT
BACKGROUND: Many screening programs have been implemented for the general population; however, dermatology appointment wait times continue to be long. Changes in scheduling would allow patients with suspicious skin lesions access to more immediate care. OBJECTIVES: The objective was to introduce a method for decreasing dermatology appointment wait times to allow patients with a high-risk skin lesion to be seen in a more efficient manner. METHODS: A telephone screening method was developed to allow for the most suspicious lesions to be seen within 72 hours if the patient wished to do so; appointment time slots were left open in physician schedules to accommodate these patients; and wait time, procedure, and treatment data were collected and compared against national wait time data. RESULTS: A total of 233 patients were seen during this study. A total of 146 of these patients were diagnosed with a cancerous or precancerous lesion. This was 63% of the total study population. The mean wait time in actual working days was 7.44 for this same period. CONCLUSION: This program substantially decreased patient anxiety, increased patient satisfaction, increased public relations for the practice, and increased public awareness of skin cancer. The Derm Access strategy can be implemented in any practice to reduce wait times for suspicious skin lesions.
Subject(s)
Mass Screening/methods , Skin Diseases/diagnosis , Triage/methods , Appointments and Schedules , Diagnosis, Differential , Health Services Accessibility , Humans , Patient Satisfaction , Telephone , Waiting ListsABSTRACT
BACKGROUND: Atypical fibroxanthoma is a rare cutaneous spindle cell neoplasm typically found on the sun-exposed areas of the head or neck of the elderly. OBJECTIVE: We report a case of localized cutaneous metastases attributed to an atypical fibroxanthoma. METHODS: A case report and a review of the literature of metastasizing atypical fibroxanthoma are given. RESULTS: Mohs micrographic surgery was used to treat all skin lesions and currently the patient has no suspicious lesions. CONCLUSION: Metastases attributed to atypical fibroxanthoma are rare, and many prior reports may have actually been malignant fibrous histiocytoma, spindle cell melanoma, or spindle cell squamous carcinoma. Tumor depth, vascular invasion, and cutaneous tumor recurrence appear to increase risk for metastasis.
Subject(s)
Histiocytoma, Benign Fibrous/diagnosis , Skin Neoplasms/diagnosis , Aged , Aged, 80 and over , Diagnosis, Differential , Histiocytoma, Benign Fibrous/secondary , Histiocytoma, Benign Fibrous/surgery , Humans , Male , Mohs Surgery , Neoplasm Metastasis , Scalp , Skin Neoplasms/pathology , Skin Neoplasms/surgeryABSTRACT
BACKGROUND: Extramammary Paget's disease is a rare neoplasm primarily affecting apocrine gland bearing skin. Although primarily affecting the anogenital area, the tumor also rarely appears in nonapocrine bearing skin and is referred as ectopic extramammary Paget's disease. OBJECTIVE: To our knowledge, we present only the second case of ectopic extramammary Paget's disease appearing on the face. METHODS: Using Mohs micrographic surgery, a rare case of ectopic extramammary Paget's disease on the face was treated in three stages. RESULTS: At 5 months there was no evidence of recurrence. CONCLUSION: Ectopic extramammary Paget's disease is a rare disease that can be effectively treated with Mohs micrographic surgery.
Subject(s)
Facial Neoplasms/surgery , Mohs Surgery , Paget Disease, Extramammary/surgery , Facial Neoplasms/pathology , Humans , Male , Middle Aged , Paget Disease, Extramammary/pathologyABSTRACT
BACKGROUND: Melanosis is a rare, but well recognized late complication of some cases of metastatic melanoma. The precise pathogenesis is unclear. Most described cases report diffuse metastases and diffuse melanosis. OBJECTIVE: To present a case of localized melanosis secondary to locally metastatic melanoma without evidence of systemic involvement in a renal transplant patient. METHODS: Case report and literature review. RESULTS: We describe a case of localized melanosis in an immunocompromised patient without evidence of systemic metastases. The patient underwent limb perfusion and her immunosuppressive therapy has been stopped. The melanosis has not regressed; however, there has been no systemic involvement and her transplanted kidney is still functioning well. CONCLUSION: To our knowledge this is the first report of this phenomenon in an immunocompromised host.