Squamous cell carcinoma or squamous proliferation associated with nivolumab treatment for metastatic melanoma.

Nivolumab is a programmed death-1 (PD1) immune checkpoint inhibitor that treats various types of cancers including non-small cell lung carcinoma and melanoma, among others. Although it serves as an effective immunotherapy, there are many associated immune-related adverse events. Even years after the introduction of nivolumab, the breadth of its side effect profile continues to expand. We present a case of squamous cell carcinoma associated with nivolumab treatment for metastatic melanoma.

Notes from the Field: Outbreak of Hand, Foot, and Mouth Disease Caused by Coxsackievirus A6 Among Basic Military Trainees - Texas, 2015.

On July 7, 2015, a man aged 22 years reported to sick call during basic military training at Lackland Air Force Base (AFB), Texas. He had erythematous, crusted papulovesicular lesions on the extensor surfaces of the upper and lower extremities. The patient was afebrile and otherwise well, and was evaluated later that day by the dermatology service. A viral infection was considered most likely because of the patient's age, absence of fever or constitutional symptoms, and the distribution and morphology of the lesions. The initial differential diagnosis included Henoch-Schönlein purpura, parvovirus B19, and Rocky Mountain spotted fever. However, the clinical signs, including the unique morphology and distribution of grouped vesicles and papules was suggestive of hand, foot, and mouth disease (HFMD), although the patient did not have oral lesions and reported no contact with another person with HFMD. A viral culture and punch biopsy of one of the lesions were obtained.

Acral Papulovesicular Eruption in a Soldier Following Smallpox Vaccination.

Smallpox vaccination is associated with several potential cutaneous adverse reactions, ranging from benign self-limited hypersensitivity reactions to life-threatening eczema vaccinatum and progressive vaccinia. Acral papulovesicular eruption is a distinct presentation that has been described in US Military service members following vaccination with the second-generation smallpox vaccine (ACAM2000, Sanofi Pasteur Biologics Co). We describe a case of this unique cutaneous eruption and review previously described cutaneous adverse events associated with smallpox vaccination.

A worsening abdominal rash.

The confluence of 2 treatments (one appropriate, one not) led to a challenge in diagnosing this worsening rash.

Tender Subcutaneous Nodule in a Prepubescent Boy.

Eligible for 1 MOC SA Credit From the ABD This Dermatopathology Diagnosis in our print edition is eligible for 1 self-assessment credit for Maintenance of Certification from the American Board of Dermatology (ABD). After completing this activity, diplomates can visit the ABD website (http://www.abderm.org) to self-report the credits under the activity title "Cutis Dermatopathology Diagnosis." You may report the credit after each activity is completed or after accumulating multiple credits.

Rapid screening of invasive fungal infections in the hospital setting using the (1,3)-ß-D-glucan assay.

Disseminated candidiasis and other invasive fungal infections are a substantial cause of morbidity and mortality in immunocompromised and critically ill patients. Diagnosis of disseminated candidiasis via blood culture and skin biopsy can be unreliable and may delay treatment. (1,3)-ß-D-glucan (BDG) assay is a rapid, cost-effective, noninvasive diagnostic screening tool for the dermatology hospitalist to consider.

Temporal shifts in the collective dermatologic microbiome of military trainees.

BACKGROUND:  New military members undergo a highly-regimented 7-week training course during which trainees live and work within the same group of approximately 50 subjects for nearly 24 hours a day. This creates an optimal environment for assessing the impact of communal living on the collective skin microbiome. PURPOSE: The objective of this pilot study was to investigate dynamic changes of the skin microbiome in basic military trainees (BMT), in light of the unique environmental influences faced by this population. PATIENTS AND METHODS:  We evaluated collective changes in the skin microbiome of normal healthy adult basic trainees in response to communal living and universal Group A Strep prophylaxis with penicillin over the course of their initial 7-week training course. Samples from 10 flights of trainees were collected by swabbing upon arrival at Lackland AFB for their training (week 0) which is prior to prophylaxis with penicillin, at the 4 week point, and at the conclusion of their 7-week course of basic military training. Three separate high-throughput sequencing platforms and three bioinformatic pipeline analysis tools were utilized to assess the data. RESULTS: At all three time points we found that the top three bacterial genus identified were Propionibacterium, Staphylococcus, and Corynebacterium. We detected a community membership difference between the initial week 0 samples and the week 4 and 7 samples. A strong inverse correlation between Propionibacterium and Staphylococcus was noted with Propionibacterium being high at week 0 and much lower at weeks 4 and 7; conversely, Staphylococcus was low at week 0 and higher at weeks 4 and 7, this relationship was noted in both the individual and collective specimens. CONCLUSION: The collective dermatologic microbiome in the military trainee population examined exhibited a relative increase in Staphylococcus and Corynebacterium abundance coupled with a relative decrease in Propionibacterium abundance in this observational pilot study. Additional studies are needed to further assess the causal impact of communal living and widespread penicillin chemoprophylaxis.

Cutaneous reactions associated with ACAM2000 smallpox vaccination in a deploying U.S. Army unit.

Since 2003, the U.S. Army has vaccinated deploying troops for smallpox. In 2008, the U.S. military transitioned to the second-generation vaccine ACAM2000. Cutaneous adverse events associated with this vaccine are rarely characterized. We review the medical literature on cutaneous adverse events with ACAM2000 and describe four new cases that occurred in primary vaccinees at Fort Wainwright, Alaska. Four cases of disseminated papulovesicular lesions occurred out of 500 smallpox vaccinations given at Fort Wainwright, Alaska. Each case was followed by dermatology and preventive medicine. Biopsy specimens were examined at Walter Reed Army Medical Center and the U.S. Centers for Disease Control and Prevention. Three of the cases had variable clinical history of dermatitis. Case 1 experienced the most extensive lesions and case duration, and Case 4 the least. All biopsy sample results confirmed immune-mediated hypersensitivity. This study relied on self-reporting and on surveillance by unit medical staff to identify cases. Each case also received multiple other concurrent vaccinations. Further study is needed to increase our knowledge of these cutaneous reactions and demonstrate possible associated or causal factors.