Complex Management of Basal Cell Carcinoma in a Frail Patient.

Basal cell carcinoma (BCC) is one of the most common cancers diagnosed in older patients and has low mortality. Surgical versus medical management is considered in patients with multiple comorbidities and limited life expectancy (LLE), where the risk-to-benefit ratio must be carefully assessed. Watchful waiting (WW) is a viable option for some patients with severe LLE when follow-up care can be provided vigilantly and frequently. Special consideration should be given to morbidity factors such as tumor growth, bleeding, pain, and social withdrawal that negatively affect the quality of life. We present the case of a 75-year-old male with a past medical history of multiple system atrophy, who presented with a BCC on the ear and face. We discuss the management of this patient and factors that may have led to the inappropriate use of WW.

Subungual Verruca Vulgaris Mimicking Onychomycosis.

Nail abnormalities, or onychodystrophy, can be caused by various pathologies, including fungal and nonfungal infections. These can result in difficulties with nail trimming, pain, and social discomfort that can significantly impact a patient's quality of life. Even experienced physicians may find it challenging to diagnose due to the lack of specificity in these changes. We present the case of a 60-year-old female who was initially diagnosed with onychodystrophy but was later found to have subungual verruca vulgaris after a nail avulsion and biopsy. This case highlights the importance of thorough diagnostic procedures and considering a broad range of differential diagnoses. We also discuss the challenges of treating subungual warts and the need for a precise therapeutic approach to ensure the best possible outcomes.

Age-related changes in male forearm skin-to-fat tissue dielectric constant at 300 MHz.

Prior research suggests that tissue dielectric constant (TDC) values are useful to assess localized skin water in females for early diagnosing breast cancer treatment-related lymphoedema and TDC values in young adults have shown gender differences. However, no TDC data are available for older males nor have ageing effects been studied despite known shifts in water state and other skin age-related changes. Thus our goals were to (i) characterize TDC values at various skin depths in young and older males, (ii) determine the dependence of these values on body composition parameters and (iii) establish inter-arm TDC ratios for use as normal male reference values. TDC measurements were made to depths of 0·5, 1·5, 2·5 and 5·0 mm bilaterally on volar forearm skin in 60 males in three groups of 20 that had mean ages ± SD of 24·0 ± 0·9, 40·0 ± 12·9 and 71·0 ± 8·0 years. Total body fat and water percentages were determined via bioimpedance at 50 KHz. Results showed that (i) for all age groups TDC values decreased with increasing depth, (ii) TDC values were not statistically different among age groups except at a depth of 0·5 mm, (iii) TDC values were highly negatively correlated with total body fat and (iv) inter-arm ratios varied little among age groups and depths. It is concluded that (i) age-related larger TDC values at only the shallowest depth is consistent with skin water shifting state from bound to more mobile in the oldest group and (ii) inter-arm ratios at any depth provide a basis to test for unilateral oedema.

Review of maintenance of response to psoriasis treatments.

BACKGROUND: Biologics are highly effective treatments for moderate-severe psoriasis with a high percentage of patients achieving 75% improvement in Psoriasis Area Severity Index (PASI75) at 12 weeks. However, psoriasis is a chronic disease, and long-term efficacy is critical. OBJECTIVE: Long-term responses of systemic psoriasis treatments and how this effect is reported. METHODS: A PubMed literature was performed to identify studies describing long-term response rates to available systemic psoriasis treatments. Within these studies, we examined how maintenance rates were reported. All studies with long-term efficacy data ranging from 24 to 244 weeks were considered. RESULTS: Thirteen studies met the inclusion criteria. When comparing medications at 1 year, response rates among the initial treatment groups were best with secukinumab (65.2%) and worst with apremilast (18.7%). Among only initial responders at 10-16 weeks who received 1 year of continuous treatment, maintenance was best with adalimumab (95.2%) and worst with apremilast (61%). LIMITATIONS: The different methodologies used to report maintenance of response over time make it difficult to compare response rates across drugs studied in different trials. CONCLUSION: Long-term response rates of systemic treatment of psoriasis are high. Effect may be influenced by many factors and can be analyzed in different ways, making comparisons across different trials difficult.