Clinical features, histology, and treatment outcomes of granular parakeratosis: a systematic review.

BACKGROUND: Granular parakeratosis is a rare disorder characterized by erythematous-brown hyperkeratotic papules and erythematous patches with scaling, occurring predominantly in the flexures and sites of occlusion. While the exact underlying pathogenesis remains unknown, there has been a wide variety of precipitating factors and treatment options reported in the literature. OBJECTIVE: We systematically reviewed and identified precipitants of granular parakeratosis, as well as its clinical and histologic features and treatment outcomes. METHOD: A comprehensive literature search was conducted using MEDLINE and Embase in March 2021. RESULTS: A total of 60 studies with 129 patients were included for analysis. An inciting factor was identified in 53.4%, the most common being topical agents including zinc oxide (17.1%), deodorant/antiperspirant (15.5%), and those containing benzalkonium chloride (7.0%). The majority presented with bilateral (68.2%) eruption of hyperkeratotic papules or erythematous patches and plaques, most frequently involving the axilla (56.5%). The prevailing histologic feature was retained keratohyalin granules within the stratum corneum in punch biopsy (97.2%) and curette (100%) specimens. Treatment options with reported success ranged from topical corticosteroids and systemic antibiotics to surgical interventions. CONCLUSION: We provide a systematic review of reported precipitants, clinical features, and treatment options that clinicians should consider when granular parakeratosis is considered.

Impact of a see-and-treat melanoma clinic on patient experience.

BACKGROUND: See-and-treat ('one stop') clinics for cutaneous and noncutaneous tumor streams have been shown to enhance patient experience, amongst other benefits, such as reduced waiting time to surgery if required. To date, there have been no studies assessing patient perception of one-stop clinics dedicated to the diagnosis and treatment of melanomas and pigmented lesions. OBJECTIVE: To perform a prospective survey study examining patient's perception of a see-and-treat pigmented lesion clinic. METHODS AND MATERIALS: Consenting patients were contacted by phone to complete a survey comprising 10 statements relating to different facets of the clinic, four weeks after their initial assessment. Reponses were documented on a 5-point Likert scale. RESULTS: A total of 107/142 (75.4%) patients consented to partake in the study. Compared to overall mean response, patients who underwent same-day biopsy reported higher satisfaction (4.9 vs. 4.5, p < .01) and perceived convenience (4.8 vs. 4.4, p < .01). Of those who received same-day procedures, no patient reported being given insufficient time to consider surgical treatment. CONCLUSION: A see-and-treat model for pigmented lesions, incorporating same-day excisional biopsy for lesions suspicious for melanoma, is viewed upon favorably by patients.

Itraconazole in the treatment of basal cell carcinoma: A case-based review of the literature.

Itraconazole is as an anti-fungal agent with the ability to inhibit the Hedgehog signalling pathway, which makes it a candidate drug that can be repurposed for the treatment of basal cell carcinomas (BCCs). We present a case of metastatic BCC, treated with oral itraconazole 100 mg twice daily, that resulted in sustained partial regression of metastatic pulmonary nodules. A systematic review on the clinical outcomes of BCCs treated with itraconazole highlights that current evidence for its clinical application remains limited and that this is the first case report where itraconazole monotherapy has achieved favourable response in metastatic BCC.

Multidisciplinary Pigmented Lesion Clinic at Auckland District Health Board: impacts on melanoma diagnosis and treatment outcomes.

AIM: To investigate the outcomes and effect of a multidisciplinary 'see and treat' pigmented lesion clinic, run jointly by dermatology and general surgery, on the diagnosis and treatment of melanoma at Auckland District Health Board (DHB). METHOD: All patients attending the newly established Pigmented Lesion Clinic (PLC) between 1 March 2019 and 31 August 2019 were included in the study. They were compared against a retrospective cohort of patients seen for suspected or biopsy-proven melanomas during the same corresponding period in 2016. RESULTS: 251 new patients attended the PLC, compared to 148 new patients seen at Auckland DHB in 2016. There was a significant reduction in proportion of pigmented lesions requiring biopsy (35.2% vs 64.3%, p<0.001), with a benign-to-malignant ratio of 2.4:1. Fifty-three melanomas were treated through the PLC, with a significant reduction in mean waiting time from referral to first specialist assessment (22.6 vs 35.1 days, p=0.038), and from referral to wide local excision (50.6 vs 99.1 days, p<0.001). 86.5% of patients received full skin check, from which additional skin malignancies were detected in 1-per-5.3 patients. CONCLUSION: The novel PLC model has led to reduction in unnecessary excisional biopsies of benign pigmented lesions, while streamlining and improving timely access to specialist review and surgical treatment for patients with melanomas.