Submammary Granular Parakeratosis Treated With Mastopexy.

Granular parakeratosis, originally named axillary granular parakeratosis, is an uncommon disease with an unclear etiology. It is thought to result from defective processing of profillagrin to fillagrin, causing retention of keratohyaline granules in the epidermis. A myriad of causative factors has been proposed, including friction, moisture, heat, and contact irritants such as deodorants. We present a case in the inframammary area that resolved with mastopexy, further supporting the role of friction, moisture, and heat. Furthermore, we present electron microscopic evidence demonstrating non-degraded keratohyaline granules upon epidermal maturation. This entity, we believe, is reactive and represents a protective response of the body to moisture and heat.

J Drugs Dermatol. 2017;16(8):810-812.

Unilateral telangiectasia macularis eruptiva perstans of the breast.

We report a case of a 22-year-old female with an asymptomatic telangiectatic rash involving her left breast of 10 years' duration. Biopsies revealed cularis findings consistent with telangiectasia m a eruptiva perstans (TMEP). Telangiectasia macularis eruptiva perstans most often presents in a symmetric fashion; our patient represents an unusual case of unilateral TMEP involving the breast. Therefore, TMEP should be considered when a patient presents with telangiectasia, even if the presentation is unilateral.

Advances in the chemoprevention of non-melanoma skin cancer in high-risk organ transplant recipients.

Patients with a history of more than four basal cell carcinomas (BCCs) or squamous cell carcinomas (SCCs) are at high risk for developing further skin cancers. Immunosuppressed patients, especially solid organ transplantation patients, harbor a higher risk of developing SCC. Systemic retinoids have been demonstrated to possess chemoprophylactic properties in the treatment of non-melanoma skin cancer. This article reviews the efficacies of the available oral retinoid agents in the chemoprophylaxis of SCCs in high-risk solid organ transplant recipients.

Profound proliferating angiolymphoid hyperplasia with eosinophilia of pregnancy mimicking angiosarcoma.

Angiolymphoid hyperplasia with eosinophilia (ALHE) is a rare benign vascular proliferation that clinically manifests as nodules and papules of the head and neck region. We report a profound, rapidly proliferating case of ALHE in a 3-week postpartum woman that clinically mimicked angiosarcoma. The clinical and histologic features of ALHE, Kitamura disease, and cutaneous angiosarcoma are reviewed, and the relationship between ALHE and pregnancy is discussed.

Advances in immunostains used in Mohs surgery.

In recent years, Mohs micrographic surgery (MMS) has become a widely utilized method of removal for a variety of cutaneous neoplasms. Certain clinical scenarios, however, make it difficult to visualize residual tumor cells, potentially decreasing the efficacy of the Mohs procedure. Immunohistochemical (IHC) stains are now available and are being utilized to delineate cells of interest intraoperatively when routinely stained slides are equivocal. While useful, IHC stains have not gained wide acceptance as an adjunct to MMS, particularly due to increased processing time, cost and workload required. There have been multiple recent advances, however, in the utilization of IHC stains in MMS. In this article, the authors discuss recent advances in IHC stains used in MMS for the treatment of melanoma as well as nonmelanoma skin cancers, potentially making their routine use in select cases more feasible.

The role of phototherapy in cutaneous T-cell lymphoma.

Cutaneous T-cell lymphoma (CTCL) is a type of non-Hodgkin's lymphoma characterized by the malignant proliferation of T lymphocytes in the skin. Phototherapy has been proven an effective treatment modality for CTCL, in particular early stage disease (patch and plaque). Specifically, broadband ultraviolet B (BB-UVB), psoralen and ultraviolet A (PUVA), and more recently narrowband UVB (NB-UVB) are the skin-directed phototherapies typically utilized. Phototherapy poses the risk of sunburn, photoaging and photocarcinogenesis. Combination therapies with IFN-alpha, retinoids (acitretin and isotretinoin) and rexinoid (bexarotene) are adjunctive systemic therapies that facilitate enhanced therapeutic response and often allow for lower doses of phototherapy. Extracorporeal photopheresis (ECP) has also been shown to be effective in more advanced stage disease.

Merkel cell carcinoma: clinical characteristics, markers, staging and treatment.

Merkel cell carcinoma (MCC) is a highly aggressive neoplasm affecting primarily the elderly Caucasian population. Earlier detection of this neoplasm may achieve a better prognosis and an improved outcome. Here, the authors review the typical clinical features of MCC to serve as a reference tool for clinicians in determining when a biopsy may be warranted. An array of immunohistochemical markers may be utilized to differentiate MCC from other neuroendocrine tumors. The staging and concomitant treatment options of MCC are discussed. In addition, the authors review therapeutic advances for treatment of MCC utilizing an array of target proteins.

Mohs surgery for melanoma in situ: how we do it.

The advent of rapid immunostains has made the use of Mohs surgery to treat melanoma more practical. Mohs surgery is especially useful in the management of lentigo maligna, which often has indistinct clinical margins. The authors describe their technique for treating melanoma in situ with Mohs surgery.

Discussing sentinel lymph node biopsy with your melanoma patients.

Sentinel lymph node biopsy, indicated for stage 1B/2 melanoma may be an underutilized diagnostic modality. Experts in the field agree that sentinel lymph node biopsy should be offered to patients with T1 melanomas with primary tumor ulceration, a mitotic rate greater than or equal to 1/mm2, and/or Clark level IV/V invasion especially if tumor thickness exceeds 0.75 mm. It is the responsibility of practitioners to characterize patients as eligible or non-eligible for the sentinel node procedure. Furthermore, it is important to obtain a fully informed consent and explain to patients the statistics of the progonostic information garnered by the test.

The role of maintenance phototherapy in cutaneous T-cell lymphoma.

Phototherapy is well-recognized as effective therapy in early stage cutaneous T-cell lymphoma (patch and plaque), often resulting in complete clearance of clinical disease and subsequent remission. Although not curable, long-term remission can often be attained utilizing maintenance phototherapy, consisting of a course of less frequent treatments over time. Herein, the authors review the literature regarding the role of maintenance phototherapy in cutaneous T-cell lymphoma (CTCL) and its success in prolonging clinical remission and disease-free survival in CTCL.

Unilateral lichen planus pigmentosus mimicking acral lentiginous melanoma.

The authors report a case of a Latin American woman who developed progressive pigmentation primarily involving two digits of her right hand. She was scheduled for amputation based on a presumptive histologic diagnosis of melanoma with regression. Dermatology consultation with repeat biopsies disclosed a lichenoid tissue reaction with marked pigment incontinence and no evidence of melanoma. This report should prompt physicians to include lichen planus pigmentosus in the differential diagnosis of acral lentiginous melanoma.

Familial pityriasis rubra pilaris: report of a family and therapeutic response to etanercept.

Pityriasis rubra pilaris (PRP) is an uncommon dermatosis of unknown etiology. The familial subtype is rare and usually presents as type V PRP. It is generally inherited in an autosomal dominant fashion with variable expression. Other forms of inheritance, such as autosomal recessive and X-linked, have also been reported. The use of etanercept in treating resistant forms of PRP is promising given reports of its success in a few cases. Herein, the authors report two cases of PRP arising in a mother and son and review the rare familial subtype of this disease. In addition, a successful therapeutic trial of etanercept was initiated in the mother based on case reports of its efficacy in other patients with PRP.

The effects of alcohol and drug abuse on the skin.

Skin changes associated with alcohol and drug abuse can be the earliest clinical manifestation of these disorders. The signs associated with these conditions may be distinctive and easily recognizable. Alcohol abuse can present with jaundice, pruritus, hyperpigmentation, and urticaria. Commonly associated vascular changes include spider telangiectasias, angiomas, caput medusas, flushing, and palmar erythema. Disease states related to alcohol abuse include psoriasis, porphyria cutanea tarda, and nutritional deficiencies. Alcohol abuse may predispose to the development of carcinomas of the skin, oropharynx, liver, pancreas, and breast. Cutaneous signs of drug abuse include skin granulomas, ulcerations, and recurrent infections. Specifically, oral disease and tooth decay are examples of stigmata often associated with methamphetamine abuse, a popular and inexpensive drug now on the scene. By being cognizant of these cutaneous markers of alcohol and drug abuse, dermatologists are often in the unique position of being able to recognize these changes, prompting early diagnosis and intervention, hopefully resulting in a better clinical outcome for these troubled patients and their families.

Actinic keratoses: past, present and future.

Actinic keratoses (AKs) are cutaneous neoplasms composed of proliferations of cytologically aberrant, epidermal keratinocytes caused by prolonged exposure to ultraviolet radiation. Combining the evidence that AKs are the second most common reason for visits to the dermatologist and it is generally believed that they should be treated, it is no surprise that the direct cost of the management of actinic keratoses in the United States (U.S.) is exceedingly high. There are currently numerous treatment modalities with more on the way as there is a demand for formulating newer, cheaper, less painful and less invasive means. The future of AK treatment involves both the continued investigation of current novel therapies, as well as the development of new treatment modalities.

Sentinel lymph node biopsy in melanoma: Facts and controversies.

Three decades after its introduction in the 1990s, the sentinel lymph node biopsy for patients with localized cutaneous melanoma is still the subject of great debate in dermatology. Many questions remain unanswered, and studies currently in progress may or may not bring us any closer to determining the truth about sentinel lymph node biopsy and melanoma. We discuss the effect of sentinel lymph node biopsy on overall survival, the clinical and therapeutic implications of sentinel lymph node biopsy, and the melanoma patients who might be candidates for sentinel lymph node biopsy.

Measures of cutaneous human papillomavirus infection in normal tissues as biomarkers of HPV in corresponding nonmelanoma skin cancers.

Cutaneous human papillomavirus (HPV) may be associated with the development of nonmelanoma skin cancer (NMSC), as suggested by reports of HPV DNA in NMSC tumors. HPV has also been investigated as an NMSC risk factor in epidemiologic studies, although findings vary across studies that used different biomarkers of HPV infection in normal tissues. To identify appropriate biomarkers for use in future epidemiologic studies, we conducted a sampling validation study. NMSC tumor tissue was obtained from 20 patients with pathology-confirmed basal or squamous cell carcinoma of the skin, in addition to several normal tissues, including eyebrow hairs, normal skin swabs obtained using multiple techniques, normal skin punch and shave biopsies, and serum for antibody measurement. Presence of cutaneous HPV DNA in tissues was measured with multiplex PCR using HPV type-specific primers and array primer extension (APEX) for HPV typing. Antibody detection was based on glutathione-S-transferase capture ELISA in combination with fluorescent bead technology. Using HPV DNA in tumor tissues as a gold standard, sensitivity and specificity were calculated for each measure of HPV infection in normal tissues. beta-Papillomavirus DNA was observed in tumor tissues in 60% of patients. The normal skin punch biopsy demonstrated optimal sensitivity (75%) and specificity (75%). Biomarkers obtained using less-invasive techniques demonstrated poor specificity when considered individually, although specificity improved when biomarkers were combined. Based on the current case series, the combinations of antibodies+eyebrow hairs or antibodies+eyebrow hairs+Dacron swabs are the optimal, minimally invasive markers of cutaneous HPV infection for use in epidemiologic studies.