Perceived Benefits of a Research Fellowship for Dermatology Residency Applicants: Outcomes of a Faculty-Reported Survey.

Dermatology continues to represent one of the most competitive specialties for medical students to match into for residency. The number of publications reported by applicants contributes to this competitiveness. Many students hoping to obtain a dermatology residency position are completing research fellowships (RFs) prior to applying. We conducted a survey to determine if those involved in the residency selection process recommend completion of an RF and how they view the perceived benefits of RF completion.

Smokeless tobacco keratosis.

Smokeless tobacco keratosis is a benign lesion characterized by the formation of white, gray, or pale macules or papules with wrinkling or rugae. It forms in the oral mucosa in response to the use of smokeless tobacco products. We present a 50-year-old man with an extensive history of smokeless tobacco use and development of the characteristic lesion. Shave biopsy showed typical changes of this benign condition and tobacco cessation was recommended.

What Percentage of Hairs Are Infected in Biopsies of Fungal Folliculitis?

Fungal folliculitis (including tinea capitis and Majocchi granuloma) has a wide range of clinical presentations, and biopsy may be obtained to distinguish this from other conditions with similar presentations. The study aims to evaluate the proportion of hairs infected in biopsies of fungal folliculitis. Copath records were searched for diagnoses of fungal folliculitis, tinea capitis and Majocchi granuloma between 1 January 2000 and 31 December 2020. Confirmed cases were pulled and reviewed by a dermatopathologist to count the total number of hairs on the sample and the total infected. Of 72 included cases, the median number of hair follicles per biopsy was 3 (IQR 1,4), and the median proportion of hairs infected was 54.2% (IQR 33.3%, 100.0%). Nineteen (26.4%) had only one hair included in the biopsy which was also an infected hair (100% of hairs were infected). The percentage of total hair follicles infected differed significantly depending upon location (p = 0.0443), with a smaller percentage of infected hairs in biopsies of tinea capitis. Clinicians should be cautious when using biopsy for diagnosis of fungal folliculitis, specifically, when there are few hairs in the specimen. Failure to capture infected hairs leads to false negative diagnoses.

What's Eating You? Caterpillars.

Caterpillar envenomation is a worldwide problem, with manifestations ranging from dermatitis to iridocyclitis and a fatal hemorrhagic diathesis. This article focuses on the diagnosis and management of dermatoses related to caterpillars.

Diagnosis of pili trianguli et canaliculi by frozen section: A rapid and inexpensive method of diagnosis.

We present frozen section as a novel method in the diagnosis of pili trianguli et canaliculi that may serve as a more time- and resource- efficient alternative to current gold- standard electron microscopy. In this case series, three children between ages one and four presented with blonde hair unable to be combed into place. Frozen section was performed and evaluated under light microscopy with easy visualization of the hair shaft abnormality, consistent with the diagnosis of pili trianguli et canaliculi.

Reliability of biopsy margin status for basal cell carcinoma: a retrospective study.

The reporting of biopsy margin status for basal cell carcinoma (BCC) varies among dermatopathologists. For biopsy specimens with seemingly negative margins, the question arises if the tumor extends beyond the margin in unexamined sections. We sought to determine the reliability of negative margin status for BCC and identify if any factors were predictive of positive true margins. We examined BCC biopsy specimens initially determined to have negative margins after routine sectioning and re-evaluated the margin status after complete tissue block sectioning of the initial biopsy specimen was performed. Our findings remind clinicians of the limitations of margin assessment and provide impetus for dermatopathologists to consider modifying how margin status is reported.

Impact of provider attire on patient satisfaction in an outpatient dermatology clinic.

Provider attire has been studied as a potential vector for infectious microorganisms in the medical setting as well as a potential factor in patient satisfaction. Our objective was to determine if a change from formal attire to fitted scrubs had a measurable impact on patient satisfaction scores in an outpatient dermatology setting. We designed a 2-year retrospective cohort study of 22 providers in an outpatient dermatology setting who transitioned from formal attire to fitted scrubs and had at least 12 months of patient satisfaction scores (measured by a third-party patient satisfaction survey) before and after the change in attire. The primary outcome was statistically significant change in patient satisfaction scores before and after the institution of fitted scrubs. A total of 3511 completed surveys were evaluated from the 12 months prior to the change in attire (study period 1), and 4191 completed surveys were evaluated in 12 months after the change (study period 2). No significant change was seen in the overall survey responses. A small but statistically significant improvement was noted for several questions in study period 2, which suggested that a change from formal attire to fitted scrubs did not have a strong impact on patient satisfaction scores. Factors beyond provider attire likely have the greatest impact on patient satisfaction.

Invasive penile squamous cell carcinoma.

Invasive penile squamous cell carcinoma (PSCC) is a rare malignancy with considerable morbidity and mortality. Because a delayed or incorrect diagnosis can have a devastating outcome, physicians should maintain a high index of clinical suspicion for PSCC in patients presenting with penile lesions, particularly in young or middle-aged patients in whom presentation of PSCC is uncommon. We report the case of a 27-year-old circumcised man who presented with invasive PSCC following a diagnosis of condyloma 8 years prior. The patient underwent robotic laparoscopic bilateral pelvis and inguinal lymph node dissection and re-excision of the primary PSCC, with one of 15 superficial right inguinal lymph nodes testing positive for squamous cell carcinoma. Given the patient's single-node positivity as well as the risks associated with chemotherapy with respect to his concurrent medical conditions, close follow-up with repeat imaging was planned following surgery. This case highlights the importance of biopsy in any lesion recalcitrant to conventional treatment modalities regardless of age. Early detection and treatment of PSCC can prevent organ dysfunction, loss of organ, or even death.

Acquired epidermodysplasia verruciformis occurring in a renal transplant recipient.

Acquired epidermodysplasia verruciformis (EDV) is a rare condition occurring in patients with depressed cellular immunity, particularly individuals with human immunodeficiency virus (HIV). Acquired EDV is less commonly reported in recipients of stem cell or solid organ transplantation. This condition typically manifests within 5 years of initial immunosuppression and can present as multiple hypopigmented to red, tinea versicolor-like macules or as multiple verrucous, flat-topped papules distributed over the trunk, arms, and legs. Human papillomavirus (HPV) types 5 and 8 are the most commonly isolated EDV-HPV subtypes as well as the most oncogenic subtypes, carrying the greatest risk for malignant transformation into squamous cell carcinoma (SCC). We present the case of a 44-year-old renal transplant recipient who developed multiple hypopigmented papules on the chest and neck with histopathology showing characteristic changes of EDV.