Wide Local Excision Before Sentinel Lymph Node Biopsy in Melanoma.

BACKGROUND: Current guidelines suggest that wide local excision of thick melanomas be delayed until sentinel lymph node biopsies can be performed. OBJECTIVE: To examine the literature and determine if there is a scientific basis for delaying wide local excision of thick melanomas. MATERIALS AND METHODS: A narrative review of the literature was undertaken to examine all available studies on the subject. RESULTS: There is no evidence that prior excision compromises sentinel lymph node identification. There are multiple unsubstantiated suggestions that large rotation flaps may lead to false negatives. CONCLUSION: There is no basis for delaying wide local excision of thick melanomas until a sentinel lymph node biopsy can be performed.

Purpura Fulminans Following Toxic Epidermal Necrolysis-Like Presentation of Spontaneous Linear IgA Bullous Disease.

Purpura fulminans (PF) is a life-threatening disease of cutaneous microvascular thrombosis and hemorrhagic necrosis. Linear IgA bullous disease (LABD) is an autoimmune disease of subepidermal blistering. We present the first known case of PF following a toxic epidermal necrolysis-like presentation of spontaneous LABD in a 70-year-old female.