Basosquamous carcinoma and metatypical basal cell carcinoma: a review of treatment with Mohs micrographic surgery.

BACKGROUND: Basosquamous carcinoma (BSC) and metatypical basal cell carcinoma (MBCC) are uncommon tumors poorly defined in the literature. Available studies suggest these tumors carry a greater risk of recurrence and metastases than basal cell carcinomas (BCCs) and, in some studies, squamous cell carcinomas. Formal treatment recommendations are not fully established. OBJECTIVE: To analyze BSC and MBCC separately, evaluate whether they are distinct tumor subtypes, and analyze Mohs micrographic surgery (MMS) efficacy for BSC and MBCC. METHODS: Retrospective review of medical records and histologic specimens was conducted for 293 patients with 303 biopsy-proven BSCs or MBCCs treated with MMS between 1996 and 2004. In total, 32 BSCs and 128 MBCCs were identified. Surgical and follow-up data were analyzed. RESULTS: Kaplan-Meier estimates of recurrence-free survival after MMS were 100% at one year for both tumor subtypes and were 100% for BSC and 93.8% for MBCC at 5 years. Initial mean sizes were 1.5 cm for BSC and 1.3 cm for MBCC. Approximately 7% represented recurrent tumors at surgery. Of six patients with recurrences, none had known metastatic disease. LIMITATIONS: Limitations include retrospective design, analysis of only head and neck sites, and small sample sizes. CONCLUSION: BSC and MBCC showed no significant distinguishing characteristics to separate them into two BCC subtypes. Reported recurrence rates for BSC and MBCC are 12-45% with wide local excision; estimated recurrence rates are 4.1% with MMS. Our study showed recurrence-free survival of 95.1% at five years. Hence, MMS is effective in treating these BCC subtypes.

The efficacy and safety of rituximab in refractory pemphigus: a review of case reports.

Rituximab is a chimeric murine-human monoclonal antibody that targets the CD20 antigen found on B cells and results in rapid depletion of this cell population. It is indicated for patients with relapsed or refractory, low-grade or follicular, CD20-positive, B cell non-Hodgkin's lymphoma. In addition, rituximab has been used for many other diseases, including refractory pemphigus. In this study, 42 case reports of patients with refractory pemphigus vulgaris, pemphigus foliaceus, and paraneoplastic pemphigus treated with rituximab were reviewed for clinical efficacy and safety. Forty-one of the 42 patients had at least some improvement following the rituximab therapy, while 6 suffered infectious adverse events. Though rituximab appears to be effective in the treatment of refractory pemphigus diseases, further studies are warranted to clarify its overall safety, especially concerning the risk of infectious adverse events in this patient population.

Recalcitrant papulopustular rosacea in an immunocompetent patient responding to combination therapy with oral ivermectin and topical permethrin.

A 68-year-old healthy man presented with papulopustular rosacea (PPR) recalcitrant to multiple therapies, including permethrin cream 5%. Histologic examination detected the presence of chronic folliculitis and numerous Demodex organisms. A diagnosis of rosacealike demodicidosis was rendered, and the patient was treated with oral ivermectin and permethrin cream 5%, resulting in resolution of the folliculitis. Demodex infestation should be considered in any patient with rosacealike dermatitis resistant to conventional rosacea therapies. If infestation is demonstrated in these patients, oral ivermectin in combination with topical permethrin is a safe and effective therapeutic option.