RESUMO
BACKGROUND: Mohs micrographic surgery requires focused attention that may lead to tunnel vision bias, contributing to not recognizing skin cancer at nearby sites. OBJECTIVE: It is to determine if a subsequently diagnosed skin cancer was visible at the time of Mohs surgery. METHODS: A retrospective chart review was performed at a single academic center from 2008 to 2020. Patients who underwent at least two distinct MMS procedures, separated in time to capture subsequent tumors, were included. RESULTS: Four hundred and four individual patients were identified with at least two distinct Mohs procedures, which generated 1,110 Mohs sequences. Fifty-one (4.6%) clinically apparent tumors went unrecognized and 127 (11.4%) tumors were identified and biopsied during the visit. High-risk tumor histology was identified in 10 (20%) unrecognized tumors and 31 (24%) recognized tumors (p-value 0.491). CONCLUSION: Our study suggests that Mohs surgeons may be overlooking adjacent skin cancers when focusing only on the tumor being surgically treated. Tunnel vision bias may account for part of this phenomenon.
RESUMO
Whitening of the nail, or leukonychia, can have a wide range of etiologies including genetic disorders, trauma, poisoning, autoimmune disorders, and infections. Here we detail a case of idiopathic acquired leukonychia totalis in a 17-year-old boy. This condition has been reported 13 times in the literature previously, with only young boys being affected. Proper diagnosis may help minimize unnecessary investigations and prevent additional psychological stress over whether an underlying disease is present.
Assuntos
Hipopigmentação , Doenças da Unha , Adolescente , Humanos , Masculino , Doenças da Unha/congênito , Doenças da Unha/diagnóstico , Doenças da Unha/etiologia , UnhasAssuntos
Disparidades nos Níveis de Saúde , Melanoma/secundário , População Rural/estatística & dados numéricos , Neoplasias Cutâneas/patologia , População Urbana/estatística & dados numéricos , Feminino , Humanos , Iowa/epidemiologia , Masculino , Melanoma/diagnóstico , Melanoma/mortalidade , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Programa de SEER , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/mortalidadeAssuntos
Hipertensão/tratamento farmacológico , Rosácea/induzido quimicamente , Vasodilatadores/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Hospitais , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Vasodilatadores/uso terapêuticoRESUMO
Pembrolizumab is a humanized IgG4 isotype mAb that the targets and blocks the programmed cell death protein 1 receptor on lymphocytes. Its use in treating metastatic melanoma is associated with increased overall survival compared to other older immunotherapies. Several adverse effects have been noted including both systemic and cutaneous manifestations. As a relatively novel treatment option, many new cutaneous manifestations are still being observed, occurring at various times after initiation of therapy. Previously noted cutaneous adverse effects include sarcoid-like reactions, rash, and changes in preexisting lesions or scars. Here we present a case in which biopsy-proven morphea developed after completion of pembrolizumab therapy.