ABSTRACT
BACKGROUND/OBJECTIVES: Therapeutic approaches to keratinocyte carcinoma rely on the accuracy of the biopsy to correctly identify, grade or subtype the tumour. Several studies have investigated the frequency and nature of histopathological discordance between the biopsy and final excision specimen. We analysed information extracted from an Australian Mohs micrographic surgery (MMS) database and compared similar studies. METHODS: An Australian MMS database was retrospectively reviewed for a period of one year. Correlation was made between the preoperative lesion diagnosis based on the formal pathology report and the histopathological results reported at the time of MMS. A systematic PubMed review of similar articles was also performed. RESULTS: A total of 464 cancers (406 BCC and 58 SCC) in 399 patients were included. The overall discrepancy rate in the histopathological classification of keratinocyte carcinoma in our study (42.2%) and the proportion of cases in which the biopsy underestimated the aggressiveness of the tumour (12.9%) were consistent with those found in similar studies. The percentage of biopsies that failed to identify an aggressive BCC subtype (31.6%), and that of biopsy-proven superficial BCC that demonstrated an invasive component in MMS (79.3%), were higher in our study than in comparable studies. The high prevalence of mixed histopathological subtypes, especially amongst BCC with discordant histopathological results, appeared as an important contributing factor. CONCLUSIONS: Despite subtle differences, the results from this Australian study support the results from similar studies and highlight that the biopsy report should be carefully interpreted in combination with the clinical findings.
Subject(s)
Carcinoma, Basal Cell/pathology , Carcinoma, Squamous Cell/pathology , Mohs Surgery , Skin Neoplasms/pathology , Australia , Biopsy , Carcinoma, Basal Cell/surgery , Carcinoma, Squamous Cell/surgery , Female , Humans , Male , Middle Aged , Retrospective Studies , Skin Neoplasms/surgeryABSTRACT
High-frequency ultrasonography (HFUS) represents a useful adjunct for dermatologists in the diagnosis of capillary malformation-arteriovenous malformation (CM-AVM) syndrome. We present a paediatric case series of 6 patients with confirmed RASA1 gene mutation in whom HFUS demonstrated AVM beneath cutaneous CM-like lesions greater than 1.5 cm.
Subject(s)
Arteriovenous Malformations/diagnostic imaging , Capillaries/abnormalities , Port-Wine Stain/diagnostic imaging , Ultrasonography, Doppler, Color/methods , Capillaries/diagnostic imaging , Child , Child, Preschool , Female , Humans , Infant , MaleABSTRACT
High-frequency ultrasonography represents a promising tool for pediatric dermatologists. It is a noninvasive and harmless diagnostic technique that is especially appealing when working with children. It can be easily performed at the patient's bedside, avoiding diagnostic delays, sedation, or multiple visits. It represents a useful adjunct to clinical examination and aids our understanding of cutaneous pathology. In this second part, we describe the ultrasonographic findings of developmental anomalies and vascular lesions.
Subject(s)
Branchial Region/abnormalities , Craniofacial Abnormalities/diagnostic imaging , Lymphatic Abnormalities/diagnostic imaging , Nervous System Malformations/diagnostic imaging , Pharyngeal Diseases/diagnostic imaging , Skin Abnormalities/diagnostic imaging , Ultrasonography/methods , Vascular Malformations/diagnostic imaging , Branchial Region/diagnostic imaging , Child , Cysts/diagnostic imaging , HumansABSTRACT
High-frequency ultrasonography represents a promising tool for pediatric dermatologists. It is a non-invasive diagnostic technique that is particularly appealing when working with children. It can be easily performed at the patient's bedside, avoiding diagnostic delays, sedation, or multiple visits. It represents a useful adjunct to clinical examination and can enhance our understanding of cutaneous diseases. Patient cooperation and limited training and experience are the main challenges for cutaneous ultrasonography in pediatric dermatology. This review describes cutaneous ultrasonography and the nuances of its use in the pediatric setting, followed by the ultrasonographic findings of cutaneous lumps, bumps, and inflammatory dermatoses commonly encountered in pediatric patients.
Subject(s)
Skin Diseases/diagnostic imaging , Ultrasonography/methods , Child , HumansABSTRACT
BACKGROUND: Cutaneous ultrasonography can be challenging in children. We aim to identify the most complicated cases and the best timing for assessment. METHODS: We retrospectively reviewed sonographic exams in pediatric patients from our cutaneous ultrasonography clinic over a two-year period. Movement artifacts were classified according to their consequences and their frequency was studied in relation to the age of the patient, location of the lesion, and underlying pathology. RESULTS: The overall frequency of exams affected by movement artifacts was 16.76% (91/543) and all belonged to children younger than 4 years of age. The frequency of impaired sonographies was particularly low in patients aged 0 to 4 months (12.77%; 6/47) and particularly high in children aged from 4 to 12 months (56.60%; 60/106). Regarding location, exams were more frequently disadvantaged when assessing the head and neck area (44.53%; 61/137). In relation to pathology, developmental anomalies showed a significantly higher frequency of exams damaged by movement artifacts (41.82%; 23/55). CONCLUSIONS: Cutaneous ultrasonography without sedation can be particularly difficult in children aged between 4 and 12 months, especially when lesions are located on the head and neck and a Doppler exam is required. When assessing congenital lesions, the first four months of life are ideal for a first examination.
Subject(s)
Artifacts , Skin/diagnostic imaging , Adolescent , Age Factors , Child , Child, Preschool , Female , Head/diagnostic imaging , Humans , Infant , Male , Movement , Neck/diagnostic imaging , Retrospective Studies , Ultrasonography , Ultrasonography, DopplerABSTRACT
Permanent epicardial pacing wires are sometimes left in place and can lead to long-term complications. We report on a case of a granulomatous reaction with a cutaneous fistula secondary to the retained epicardial pacing wires in a child and highlight the relevance of sonography as an additional tool in the diagnosis and management of dermatologic conditions.
Subject(s)
Cutaneous Fistula/etiology , Foreign Bodies/complications , Granuloma, Foreign-Body/diagnosis , Pacemaker, Artificial/adverse effects , Child , Granuloma, Foreign-Body/etiology , Humans , Male , Ultrasonography/methodsABSTRACT
High-frequency ultrasonography (HFUS) can help improve dermatofibrosarcoma protuberans (DFSP) recognition. We present three cases of DFSP in which a "jellyfish-like" sonographic pattern was a useful adjunct in formulating the diagnosis. In addition, we review all DFSP ultrasound images available in the literature.
Subject(s)
Dermatofibrosarcoma/diagnostic imaging , Skin Neoplasms/diagnostic imaging , Child , Dermatofibrosarcoma/pathology , Female , Humans , Male , Middle Aged , Skin Neoplasms/pathology , UltrasonographyABSTRACT
High-frequency ultrasonography is a bedside tool increasingly used for the assessment of skin lesions, but there have been few reports about its importance in children with skin signs of hematologic disease. We present three cases to highlight the usefulness of high-frequency ultrasonography in assisting with the diagnosis of these skin lesions.
Subject(s)
Hematologic Neoplasms/pathology , Skin Neoplasms/diagnostic imaging , Ultrasonography/methods , Child , Female , Humans , Infant , Male , Skin/diagnostic imaging , Skin/pathology , Skin Neoplasms/pathologyABSTRACT
Precalcaneal congenital fibrolipomatous hamartoma is an underreported benign entity that has been described in the literature under different names. We present two cases of unilateral fibrolipomatous hamartoma (FLH) appearing in a unique location: on the posterior aspect of the foot overlying the heel. We propose the term "FLH of the skin" as a more inclusive and less confusing term for this condition, thus allowing distinction with FLH arising from neural tissue. High-frequency ultrasonography appears to be a useful diagnostic tool that may avoid unnecessary biopsies for this condition.
Subject(s)
Hamartoma/congenital , Heel/abnormalities , Child, Preschool , Female , Foot/pathology , Hamartoma/diagnosis , Humans , Infant , Male , Skin/pathology , Ultrasonography/methodsSubject(s)
B7-H1 Antigen , Lung Neoplasms , Cell Death , Hair , Humans , Immunotherapy , Programmed Cell Death 1 ReceptorABSTRACT
BACKGROUND/OBJECTIVES: A variety of congenital developmental anomalies arise on the neck because of the many fusion planes and complex embryologic structures in this region. We describe a series of seven patients with a novel type of superficial midline congenital anomaly. METHODS: Retrospective case series. Clinical and histopathologic features were compared and used to describe this entity. RESULTS: Seven patients with nearly identical clinical findings were identified. In all cases, a small superficial cyst resembling a giant milium was observed at birth. There were no significant changes during infancy and no evidence of underlying abnormalities. The histopathologic findings were identical to those of an infundibular follicular cyst. CONCLUSION: We have termed this entity midline anterior neck inclusion cyst. We believe it is a superficial developmental anomaly, probably a forme fruste of a midline fusion developmental defect, which has not to our knowledge, previously been described.
Subject(s)
Epidermal Cyst/pathology , Neck/abnormalities , Epidermal Cyst/surgery , Female , Humans , Infant , Infant, Newborn , Male , Retrospective StudiesABSTRACT
Cardiac myxoma often presents with heterogeneous symptoms and signs and represents a challenging diagnosis. The cutaneous manifestations, if present, are often transient and non-specific and the clinician must possess a high degree of suspicion to secure the diagnosis. We present the case of a 36-year-old woman with a 6-month history of intermittent, painful, violaceous, non-blanching macules on the thumb and fingertips of the left hand and right ankle. A cutaneous embolic phenomenon was suspected and an urgent echocardiogram demonstrated an atrial mass, with subsequent histopathology confirming the clinical suspicion of atrial myxoma. Early diagnosis and excision of the tumour avoided serious complications.