Pure and Mixed Variants of Desmoplastic Melanoma: A Single-Center, Retrospective, Clinicopathologic Review.

BACKGROUND: Desmoplastic melanoma (DM) is a rare melanoma variant. Prognostic indicators and survival vary widely and are further confounded by the histopathologic distinction between pure DM (pDM) and mixed DM (mDM) subtypes. The utility of current treatment guidelines is limited by the lack of evidence-based recommendations. OBJECTIVE: To compare the clinicopathologic characteristics of pure and mixed subtypes of DMs. METHODS: All cases of DM were identified from the Washington University in St Louis institutional pathology database between January 2000 and September 2022. Fifty-two cases were identified and subsequently categorized as pure ( n = 26) or mixed ( n = 26). Clinical and histopathologic data were collected and compared. RESULTS: There were no differences in demographics or tumor location between pure and mixed subtypes. Patients with mDM were more likely to have mitoses present ( p = .03). There were no differences in Breslow depth, tumor diameter, level of invasion, ulceration, and lymphovascular or perineural invasion. The utilization of sentinel lymph node biopsy ( p = .17) and sentinel lymph node positivity ( p = .67) were also similar. CONCLUSION: Despite histopathologic distinction between pDM and mDM, these subtypes were found to have similar clinicopathologic characteristics, including similar rates of sentinel lymph node metastasis.

DEVO: an ontology to assist with dermoscopic feature standardization.

BACKGROUND: The utilization of dermoscopic analysis is becoming increasingly critical for diagnosing skin diseases by physicians and even artificial intelligence. With the expansion of dermoscopy, its vocabulary has proliferated, but the rapid evolution of the vocabulary of dermoscopy without standardized control is counterproductive. We aimed to develop a domain-specific ontology to formally represent knowledge for certain dermoscopic features. METHODS: The first phase involved creating a fundamental-level ontology that covers the fundamental aspects and elements in describing visualizations, such as shapes and colors. The second phase involved creating a domain ontology that harnesses the fundamental-level ontology to formalize the definitions of dermoscopic metaphorical terms. RESULTS: The Dermoscopy Elements of Visuals Ontology (DEVO) contains 1047 classes, 47 object properties, and 16 data properties. It has a better semiotic score compared to similar ontologies of the same domain. Three human annotators also examined the consistency, complexity, and future application of the ontology. CONCLUSIONS: The proposed ontology was able to harness the definitions of metaphoric terms by decomposing them into their visual elements. Future applications include providing education for trainees and diagnostic support for dermatologists, with the goal of generating responses to queries about dermoscopic features and integrating these features to diagnose skin diseases.

Treatment of penoscrotal basal cell carcinoma - an institutional retrospective review.

Basal cell carcinoma (BCC) of the sun-protected genital region is rare. We examined all penoscrotal BCC at a single institution over an 18-year period. A total of 7 cases were identified, 5 scrotal and 2 penile. Four cases (57%) were treated with Mohs micrographic surgery (MMS) and 3 cases (43%) with conventional excision. A prior retrospective review of vulvar BCC at our institution during the same time period showed that MMS was utilized in 4 (11%) of 35 cases. Functional preservation is vital when performing surgery on the genitals and tissue-sparing MMS provides optimal tumor clearance and outcomes for both males and females.

Erosive pustular dermatosis in a patient with lichen planopilaris treated with aminolevulinic acid photodynamic therapy.

Erosive pustular dermatosis of the scalp (EPDS) is a chronic inflammatory condition with an unclear etiology that typically occurs on sun-damaged skin of older individuals. Clinically it is characterized by sterile pustules, erosions, and crusting that can lead to scarring alopecia and skin atrophy (Yang et al., 2016; Broussard et al., 2012; Cunha et al., 2019). EPDS is a therapeutic challenge and often resistant to numerous treatments. Herein, we describe a case of erosive pustular dermatosis of the scalp in a patient with lichen planopilaris successfully treated with curettage followed by aminolevulinic acid photodynamic therapy.

Clinical Utility of Guselkumab in the Treatment of Moderate-to-Severe Plaque Psoriasis.

Psoriasis is a chronic immune-mediated disease involving complex interaction of T cells and keratinocytes. The comprehensive pathogenesis of psoriasis is not fully understood but the IL-23/Th17 axis is a central pathway in driving disease development. Guselkumab is the first treatment of moderate-to-severe psoriasis that specifically targets the p19 subunit of IL-23. The benefit of guselkumab has been established by a number of clinical trials including demonstration of greater long-term efficacy in recent comparator trials. This review addresses the results of head-to-head trials (ECLIPSE, IXORA-R, and POLARIS) that compared guselkumab to secukinumab, ixekizumab, and fumaric acid esters. The previously demonstrated long-term efficacy of guselkumab has been corroborated by many recently published studies. The effective and safe profile, convenient dosing, and improved quality of life in patients make gulselkumab a viable first-line treatment option for moderate-to-severe psoriasis.

Cutis marmorata telangiectasia congenita with painful ulcerations.

Cutis marmorata telangiectatica congenita (CMTC) is a rare, congenital, vascular disorder that may sometimes be associated with ulcerations of the involved skin. We present a case of CMTC, asymptomatic since birth, that began developing painful ulcerations during adolescence. Although laser therapy may benefit the superficial aspect of this vascular anomaly, the presence of deeper involvement in lesions with ulcerations may not respond favorably to laser therapy and the best approach needs to be further evaluated.

Assessment of Epidemiological Trends in Craniosynostosis: Limitations of the Current Classification System.

Craniosynostosis affects 1 in 2,000 live births, which makes it one of the most common craniofacial abnormalities in the United States. Despite this fact, few national epidemiologic reports exist, although US and European studies have reported an increased incidence of metopic craniosynostosis. The aim of our study is to analyze the National Inpatient Sample (NIS) to support those conclusions. METHODS: We identified hospitalizations from 1998 to 2012 by using the ICD-9-CM diagnosis code for congenital anomalies of skull and face bones (756.0) and procedure codes related to craniosynostosis repair (2.01, 2.03, 2.04, 2.06). RESULTS: We analyzed data from 37,815 hospitalizations and 49,505 reconstructive procedures. There was a 61.6% increase in the number of hospitalizations related to craniosynostosis repairs. There was a 180% increase in bone graft to skull procedures, 109% increase in other cranial osteoplasty, 54% increase in formation of cranial bone flap, and a 6% decrease in opening of cranial suture. CONCLUSIONS: We observed a steady rise in the number of craniosynostosis repairs performed, but whether this is a result of a true increase in incidence, better diagnosis, or change in treatment patterns needs further research. The current classification system does not provide information about the specific suture affected (metopic, sagittal, etc.), the type of repair performed (endoscopic, fronto-orbito advancement, etc.), and whether the repair is a primary procedure or a revision. More descriptive diagnosis and procedural codes are imperative to improve the epidemiologic and outcomes data of craniosynostosis in the United States.

Efficacy of Applicator Devices for Self-Application of Topicals to the Back.

BACKGROUND: Self-application of topicals on the back can be challenging. OBJECTIVE: The aim was to assess topical back coverage using commercially available back applicators. MATERIALS AND METHODS: Ten subjects applied sunscreen to their back using their hands and then with 3 back applicators (large foam tip, small foam tip, roller tip). The amount of lotion used and the time it took to perform the application were recorded. The resulting distribution of sunscreen was assessed with a Wood's lamp; the area covered fluoresced less than the uncovered skin. Images were captured and then analyzed using an automated thresholding technique. RESULTS: Subjects applied more lotion when using the large foam tip (7.58 g, 95% CI 6.47-8.70 g; P < .004) and small foam tip (7.46 g, 95% CI 6.35-8.57 g; P < .006) applicators compared to hands alone (6.22 g, 95% CI 5.10-7.33 g). Application time was longer with the small foam tip applicator (113.4 s, 95% CI 96.7-130.1 s) relative to hand application (78.7 s, 95% CI 62-95.4 s) (P < .03). Coverage of the back was higher for the large foam tip (84.8%, 95% CI 78.4%-91.3%; P < .03), small foam tip (88.0%, 95% CI 81.6%-91.5%; P < .006), and roller tip (84.3%, 95% CI 77.9%-90.8%; P < .04) applicators compared to hand application (71.5%, 95% CI 65%-78%). The middle back tended to have less coverage when applying with the hands. CONCLUSIONS: Topical coverage of the back is improved with the use of applicator devices during self-application.

Unexplored Questions About Away Rotations - A Student's Perspective.

This article was migrated. The article was marked as recommended. Many fourth-year medical students complete away rotations as elective courses within their specialty of choice. The popularity of away rotations is increasing and has become nearly ubiquitous in certain competitive specialties ( Higgins et al., 2016). Benefits include obtaining letters of recommendation, diversifying clinical exposure, expanding research opportunities, and establishing a connection with a residency program. Some disadvantages include cost, stress, competitive nature among applicants, and separation from personal support networks. We are writing this to bring attention to the pros and cons of away rotations, and to the absence of substantial data available in the literature to help us understand the actual impact that away rotations may have on our residency matching outcomes.