Laboratory errors leading to nonmelanoma skin cancer recurrence after Mohs micrographic surgery.

BACKGROUND: Compared with standard surgical excision, Mohs micrographic surgery (MMS) provides superior cure rates for nonmelanoma skin cancer (NMSC). Although cure rates of NMSC approach 99% with MMS, local recurrences occasionally occur. OBJECTIVE: The authors sought to identify histological features during frozen section examination that were associated with local recurrence of NMSC after MMS. MATERIALS AND METHODS: A retrospective chart review was performed of patients undergoing a second MMS procedure to treat locally recurrent NMSC over a 20-month period. Histological slides were reviewed to assess for possible causes of local recurrence. RESULTS: Of 3,169 NMSCs treated, 22 were locally recurrent. Possible causes of recurrence identified after MMS included dense inflammation in the final margin at sites affected by tumor in prior slides (27%), visible remaining tumor (23%), missing epidermal or dermal tissue (23%), and actinic keratosis (4%). One recurrence was possibly explained by incorrect mapping. No abnormality could be detected in 18% of cases. Possible limitations include the small sample size, retrospective design, and the possibility that some patients may have been lost to follow-up. CONCLUSION: Local recurrences after MMS are extremely rare. When recurrences do occur, they can be attributed to errors in histological interpretation or tumor mapping.

Aggressive extraocular sebaceous carcinoma recurring after mohs micrographic surgery.

Sebaceous carcinomas (SC) are rare adnexal tumors with possible aggressive behavior usually arising in the head and neck region of adults in the seventh decade of life. Treatment has traditionally been with surgical excision with 5-6 mm wide margins but Mohs micrographic surgery (MMS) has also been reported as an effective treatment modality. We present a case of a Caucasian female renal transplant patient with a rapidly enlarging nodule on the left preauricular cheek that was excised with MMS with negative margins. The tumor recurred rapidly and metastasized ultimately leading to the death of the patient. There was some disagreement amongst pathologists as to the possible nature of the diagnosis with the original biopsy being labeled as a poorly differentiated carcinoma. We aim to highlight the potential aggressive nature of SC and review the features of the neoplasm including histological features that help in making the diagnosis.

A case of pemphigus herpetiformis occurring in a 9-year-old boy.

Pemphigus herpetiformis (PH) is a rare autoimmune vesiculobullous disease. It clinically mimics dermatitis herpetiformis and has immunofluorescent findings typical of pemphigus. PH occurs in adults more commonly than children and is often effectively treated with dapsone. We report a case of PH occurring in a 9-year-old boy that was refractory to dapsone and to various other steroid-sparing medications but resolved with methotrexate.

Hereditary mucoepithelial dysplasia: unique histopathological findings in skin lesions.

Hereditary mucoepithelial dysplasia (HMD) is a rare, autosomal dominantly inherited, multisystem disease thought to be caused by abnormalities in desmosomes and gap junctions. HMD affects the skin, mucosae, hair, eyes and lungs. Nearly all patients clinically display the triad of non-scarring alopecia, well-demarcated mucosal erythema and erythematous intertriginous plaques. Although histopathological findings of mucous membrane epithelium have been well characterized, only three reports have described histopathologic findings in the skin. We report a case with unique histopathological findings not previously reported in HMD.

The efficacy of second-intention healing in the management of defects on the dorsal surface of the hands and fingers after Mohs micrographic surgery.

BACKGROUND: The type of repair chosen to manage defects on the dorsal aspects of the hands and fingers can affect overall hand function. Preservation of manual function in these areas is critical. OBJECTIVE: To evaluate the efficacy of second-intention healing of defects on the dorsal surface of the hands and fingers after Mohs micrographic surgery and to define optimal wound parameters for choosing second-intention healing. METHODS: Fifty-nine patients who had undergone second-intention healing of a Mohs defect on the dorsum of a hand or finger were contacted and their records obtained; 48 patients completed the study. Healing by second intention was assessed according to self-evaluation and retrospective review of medical records based on six outcome variables, including functional ability, durability, sensation, and cosmetic result. RESULTS: Defects ranged in size from 0.8 to 6.0 cm. Patient records revealed no documented problems with function, durability, sensation, cosmesis, or wound infection. All patients reported excellent or good functional results and normal sensation within the scar, and most reported excellent or good scar durability and cosmesis. CONCLUSION: Second-intention healing is an effective option for repairing defects on the dorsum of the hand and fingers. Large defect size is not a contraindication for second-intention healing.

Giant merkel cell carcinoma masquerading as a benign cyst on the buttock of an african american man.

We report a case of a 60-year-old African American man who presented with a 4-year history of a previously asymptomatic, recently enlarging nodule on his left buttock, which was initially presumed to be an epidermoid cyst. Physical examination revealed a large, fixed, subcutaneous tumor, and a biopsy revealed merkel cell carcinoma. Immunohistochemical staining was positive for pankeratin, CAM 5.2, synaptophysin, and CD56 and negative for CK7, CK20, TTF-1, chromogranin, CD3, CD20, CD57, MART1, and HMB 45. The patient underwent wide local excision of the lesion with removal of the fascia overlying the gluteus and full body positron emission tomography (PET) and was found to have Stage IIb disease. He subsequently received adjuvant radiotherapy limited to the tumor bed at a dose of 60 gray.

Quality of life assessment and disease experience of patient members of a web-based hydroa vacciniforme support group.

BACKGROUND/PURPOSE: Hydroa vacciniforme (HV) is a rare photodermatosis that primarily affects children. It is characterized by photodistributed vesicles that heal with scarring. The purposes of this study are to perform the initial investigation into the effect of HV on quality of life (QoL) and gain insight into disease diagnosis and management. METHODS: Using the listserv from a web-based, international HV support group, either the Dermatology Life Quality Index (DLQI) or the Children's DLQI (CDLQI), and an HV-specific questionnaire were administered. RESULTS: Fifteen HV patients participated, nine (60%) males and six (40%) females. Median age at onset was 7 years, and 11/15 (73%) were younger than 18 years. The majority of patients were Caucasian (73%). Children cited life quality as being negatively impacted by an inability to play outdoors while adults noted QoL influences due to limitations on clothing choices. The mean CLDLQI and DLQI scores, 12.1 and 8.5, respectively, suggest a higher negative QoL impact than previously reported indices for generalized eczema, atopic dermatitis, and psoriasis. CONCLUSION: When compared with other dermatoses, HV appears to have an equal or greater impact on patients' QoL. Dermatologists should be aware of the psychosociologic impact of this disease, especially on young HV patients.