ABSTRACT
Lucio phenomenon is a rare vasculopathy that can occur in patients with Hansen disease, particularly diffuse lepromatous leprosy. It is characterized by retiform purpura and necrotic ulcerations, most commonly affecting the extremities. Diagnosing Lucio phenomenon can be challenging, especially when secondary bacterial infections occur. We report a patient with Lucio phenomenon who presented with acute necrotizing fasciitis of his left upper extremity and a 10-year history of chronic ulcerations. Shortly following admission, he also developed acute kidney injury. The necrotizing fasciitis was treated with prompt surgical debridement and intravenous antibiotics. Biopsy and PCR of a right upper extremity ulcer confirmed the presence of Mycobacterium lepromatosis. Multidrug therapy and prednisone were used to treat the Lucio phenomenon. After initiating treatment, no new lesions developed, kidney function improved, and the patient underwent successful skin graft of his left upper extremity. Although corticosteroid use is controversial, our patient's marked response to multidrug therapy with prednisone highlights the importance of this regimen in severe presentations of Lucio phenomenon. To the best of our knowledge, only two other cases of Lucio phenomenon confirmed to be caused by M. lepromatosis have been reported in living patients (rather than retrospectively identified post-mortem), underscoring the importance of the presented clinical course and treatment regimen.
Subject(s)
Acute Kidney Injury , Fasciitis, Necrotizing , Panniculitis , Vascular Diseases , Male , Humans , Leprostatic Agents/therapeutic use , Prednisone/therapeutic use , Fasciitis, Necrotizing/complications , Fasciitis, Necrotizing/diagnosis , Fasciitis, Necrotizing/therapy , Drug Therapy, Combination , Retrospective Studies , Panniculitis/drug therapy , Acute Kidney Injury/etiology , Acute Kidney Injury/drug therapy , Adrenal Cortex HormonesABSTRACT
Frontal fibrosing alopecia (FFA), a scarring type of alopecia, developed in two patients with a history of alopecia areata (AA). Both patients had biopsies to confirm this interesting series of pathology. Etiology and pathogenesis of this AA-to-FFA sequence will be discussed.
ABSTRACT
PURPOSE: To assess the clinical presentation, treatment modalities, and outcome of primary melanomas arising in ovarian cystic teratomas (OCT). METHODS: A systematic review on PubMed/MEDLINE was performed on June 5, 2017, to gather data on patients with primary melanomas arising in OCTs. No systematic reviews were identified. Consequently, only case reports and case series of individuals were analyzed. A total of 37 articles met our inclusion criteria, totaling 41 unique patients. RESULTS: The average age of diagnosis was 51.5 years. In total, 24% of patients were found to have metastatic disease. In total, 56.7% of patients eventually died of their disease, with an average time from diagnosis to death of 9.3 months. Disease recurrence was common, occurring in 65% of patients. The mainstay of treatment was surgical in 100% of the cases. Adjuvant chemotherapy, immunotherapy, and radiation were also used with varying degrees of efficacy. CONCLUSIONS: Malignant melanoma arising in OCT is a rare disease with poor prognosis. The current mainstay treatment is surgical. Potential benefits of targeted therapy, immunotherapy, and chemotherapy remain to be determined. A limitation of this study is that these melanomas have only been published in case reports.
Subject(s)
Melanoma/secondary , Ovarian Neoplasms/pathology , Teratoma/pathology , Adolescent , Adult , Aged , Aged, 80 and over , Chemotherapy, Adjuvant , Child , Female , Humans , Immunotherapy , Melanoma/pathology , Melanoma/therapy , Middle Aged , Neoplasm Recurrence, Local/drug therapy , Neoplasm Recurrence, Local/pathology , Neoplasm Recurrence, Local/surgery , Neoplasm Recurrence, Local/therapy , Neoplasms, Second Primary/pathology , Neoplasms, Second Primary/therapy , Radiotherapy , Treatment OutcomeABSTRACT
BACKGROUND: Primary male genital melanomas are rare. Of these, scrotal melanoma is the least common, and is unfortunately often detected late in the disease course. OBJECTIVE: To assess the clinical presentation, treatment modalities, and outcome of scrotal melanoma to aid clinician management. METHODS: Systematic literature review of PubMed, yielding 23 cases, of which 20 met the inclusion criteria. RESULTS: Although previously thought to have the best outcome of genitourinary melanomas, scrotal melanomas are associated with high mortality and late presentation. Scrotal melanoma presented as Stage I/II disease 18.75% of the time, Stage III 56.3% of the time, and Stage IV 25% of the time, whereas typical cutaneous melanoma presents as Stage I/II disease 84% of the time, Stage III 8% of the time, and Stage IV 4% of the time. Half of patients experienced recurrence of their disease. All patients who presented with metastases to distant organs died. LIMITATIONS: Small sample size. Few cases described a Breslow's depth making it difficult to draw conclusions on tumor thickness and survival outcome. CONCLUSION: Scrotal melanoma is rare, aggressive, and is often caught late in the disease course. The authors encourage dermatologists to educate patients and destigmatize genital lesions to increase the likelihood of earlier detection and better patient outcomes.
Subject(s)
Genital Neoplasms, Male/diagnosis , Genital Neoplasms, Male/surgery , Melanoma/diagnosis , Melanoma/surgery , Scrotum , Skin Neoplasms/diagnosis , Skin Neoplasms/surgery , Adult , Aged , Aged, 80 and over , Humans , Male , Middle Aged , Treatment OutcomeABSTRACT
Full-body skin exams (FBSE) play an integral role inearly detection and treatment of skin cancer. Promptdetection of melanoma is especially importantas survival outcomes decrease significantly withpresentation of advanced disease. Given thatmelanoma may grow in areas of skin with little to nosun exposure, genital melanomas are a recognizedentity in cutaneous oncology.
