Post-radiation lichen planus: a case report and review of the literature.

BACKGROUND: Lichen planus is a T-cell mediated inflammatory disorder of the skin and mucus membranes and is a rare complication of external beam radiation. CASE PRESENTATION: 64 year old White male who presented to dermatology with a lesion at the lateral aspect of the right thigh. The lesion was first noted 40 years prior and had grown from 1.5 cm to 6.5 cm in the ensuing years. On examination the lesion was raised, hypopigmented, with pearly borders and central ulceration. Wide excision with lymph node dissection demonstrated invasive squamous cell carcinoma, basaloid type, with negative margins. Patient had radiation therapy of the right inguinal nodes. Patient subsequently noted a "blister" on the right upper thigh, which progressed over time to flat, polygonal, intensely pruritic lesions that covered the right lateral thigh from just distal to the hip to the distal third of the femur (Figs. 1, 2). Skin biopsy was positive for lichen planus. He was started on topical triamcinolone with salutary effects on appearance and pruritus. Fig. 1 Lichen planus, right thigh Fig. 2 Closeup, lichen planus, right thigh, demonstrating polygonal papules CONCLUSION: Once more biopsy-proven cases of post-radiation lichen planus are reported, hopefully the exact mechanism can be elucidated. This may identify risk factors and aid in treatment, with the goal of limiting radiation toxicity and palliation of symptoms that may affect the quality of daily life.

Anterior Cruciate Ligament Stability in Soft-Embalmed Cadaver vs In vivo Knee: Alternative Approaches to Medical Education.

Introduction: Soft-embalmed cadavers have been used in medical education with a variety of success in different curriculum objectives. In the United States, the ACL is the most commonly injured ligament. Yet, there has been little focus on the stability of the knee in the sagittal plane provided by the anterior cruciate ligament within the soft-embalmed cadaver model. If the soft-embalmed cadaver ligaments contain similar elastic properties as an in-vivo knees, this will offer yet another means for further advancements in medical education to detect and assess musculoskeletal injuries. Purpose: Evaluate how similarly the anterior tibial translation of soft-embalmed cadaver anterior cruciate ligaments compares to in-vivo tissue. Methods: The KT-1000 arthrometer was used to assess the laxity of the anterior cruciate ligament of thirteen soft-embalmed cadavers consisting of five females and eight males with a mean age of 79.3 years and duration of time since embalming ranging from 250 to 1156 days. Anterior displacement of the tibia in relation to the femur was registered at 67N and 89N. The soft-embalmed cadaver measurements were compared against twenty-one healthy uninjured individuals whose anterior tibial translation was measured using the same process. Data sets were analyzed using a welch two-sample t-test to determine the similarity between the means of the data sets. Results: The t-tests proved a significant difference between live and soft-embalmed cadaver knees. The anterior tibial translation in the set of healthy live knees directly compared to the soft-embalmed cadaver group for 67N depicts an average difference of 1.76mm. The same comparison at 89N depicts an average difference of 2.12mm. Conclusion: While soft-embalmed cadavers may not directly replicate ATT to an exact number to that of in vivo tissue, they still allow the perception of the tibial translation against a stationary femur. The difference is less than 2.5 mm in both data sets when compared to an in-vivo knee, equivalent to one-tenth of an inch. Suggesting the viability of soft-embalmed cadavers ATT and should not exclude their use in medical education.