Anesthetic blister induction to identify biopsy site prior to Mohs surgery.

BACKGROUND: Wrong-site surgery in dermatology often occurs due to difficulty finding the initial biopsy site prior to Mohs surgery. Patients frequently present for Mohs surgery weeks to months following the initial biopsy site. Visualization of the biopsy site may become difficult at presentation due to healing.
OBJECTIVE: To investigate the utility of anesthetic blister induction at a suspected biopsy site to identify the location prior to Mohs surgery. The proposed technique is visualization of a blister that is induced by local anesthetic administration at the proposed biopsy site. The addition of this technique among others such as curettage, dermoscopy, and UV fluorescence can prevent wrong-site surgery.
METHODS: A biopsy site of a squamous cell carcinoma on a patient was compared via photography for visibility at the time of initial biopsy, weeks following biopsy, and post-anesthetic blister induction.
RESULTS: The biopsy site was easier to locate with the assistance of a blister that formed as a result of local anesthetic administration.
CONCLUSION: Blister induction by local anesthetic administration can assist in accurately identifying healed or obscured biopsy sites.

Solitary morphea profunda following trauma sustained in an automobile accident.

Solitary morphea profunda (SMP) is a variant of localized scleroderma (LS). We report the case of a 50-year-old white woman with a history of trauma sustained in an automobile accident who presented with SMP on the right upper arm. We also provide a review of the classification, epidemiology, etiology, diagnostic studies, pathogenesis, physical findings, histopathology, treatment, and prognosis of SMP, along with other important details pertaining to the disease. We also provide a brief overview of LS and morphea profunda (MP).

A review and update on melanocyte stimulating hormone therapy: afamelanotide.

Afamelanotide ([Nle4-D-Phe7]-alpha-MSH) is an analog of alpha-melanocyte stimulating hormone given as a subcutaneous injection. Afamelanotide is currently undergoing phase II and III trials in Europe and the US for skin diseases including vitiligo, erythropoietic protoporphyria, polymorphic light eruption and prevention of actinic keratoses in organ transplant recipients. Unregulated analogs and chemicals are being sold online ahead of formal approval. A number of counterfeit chemicals, 'Melanotans' are being sold for tanning purposes. Currently, afamelanotide is already on the market in Italy and Switzerland for patients with erythropoietic protoporphyria. This paper will review the current literature on this promising compound.

Diffuse dermal angiomatosis.

Diffuse dermal angiomatosis (DDA) is a benign and rare acquired, cutaneous, reactive, vascular disorder. We report a rare case of a 43-year-old man who presented with a large (15-cm diameter), indurated, hyperpigmented plaque covering the left buttock for 6 years. This report further discusses DDA with a review of the literature, including its classification, epidemiology, pathophysiology, etiology, histopathology, differential diagnosis, and current therapeutic approaches.

Keloidal Atypical Fibroxanthoma: Case and Review of the Literature.

Keloidal atypical fibroxanthoma (KAF) has recently been categorized as a variant of atypical fibroxanthoma. This paper will emphasize the importance of including KAF in both clinical and histological differential diagnosis of benign and malignant lesions which exhibit keloidal collagen and will also review the current literature on epidemiology, pathogenesis, histology, immunochemistry and treatments.

Mohs Surgery in Patients Immunobullous Diseases: Should Prednisone be Increased Prior to Surgery?

BACKGROUND: Mohs surgery is one of the most effective treatment options for skin cancers as it offers one of the highest chances for cure. Mohs surgery is a precise technique that removes a layer at a time. Although this may be advantageous, this treatment method is difficult in patients with immunobullous diseases. Currently the guidelines for Mohs surgery do not discuss the premanagement of immunobullous patients about to undergo Mohs surgery. OBJECTIVE: To advocate for increasing prednisone dose in patients with immunobullous disease prior to undergoing Mohs surgery. CASE REPORT: The authors present a case of an excision of a squamous cell carcinoma from a 94-year-old woman with a history of pemphigus vulgaris using Mohs micrographic surgery. CONCLUSION: Current preoperative guidelines for Mohs surgery do not address the issue of altering steroid medications for patients with immunobullous disease prior to the procedure. The authors suggest that patients with a history of immunobullous disease undergoing Mohs micrographic surgery should have an increase in steroid dose prior to surgery.

Eccrine poromatosis: case report and review of the literature.

Eccrine poroma (EP) is a benign tumor of the eccrine duct. Multiple EPs are defined as eccrine poromatosis (EPS), an uncommon phenomenon. To date there are only eight reported cases of EPS. This review exemplifies the epidemiology, pathogenesis, differential diagnosis, and histology of EP, while reviewing the eight cases of EPS. Six of the eight cases of EPS had a history of immunosuppression from either radiation or chemotherapy. This paper will also emphasize the importance of excision to avoid possible malignancy. Here we present a 73-year-old gentleman with EPS who was also treated with radiation and chemotherapy prior to the onset of the lesions.

Invasive ductal breast carcinoma underneath a lipoma in a male patient.

Male breast cancer is a rare malignancy and accounts for less than one percent of all cancers in men. The authors describe the case of a 76-year-old Caucasian man with invasive ductal breast carcinoma who presented with a common lipoma. This paper reviews the current literature on epidemiology, risk factors, etiology, different types of breast cancer, clinical presentation, imaging, diagnostic workup, and treatment.

A Novel Long-term Therapy of Facial Synkinesis with Botulinum Neurotoxins Type A and Fillers.

Facial synkinesis is the involuntary movement of facial muscles accompanying a voluntary movement. It is a common sequelae to Bell's palsy. The authors present a 50-year-old patient who developed facial synkinesis after Bell's palsy. Pain, discomfort, and facial asymmetry accompanied the condition. She was treated on multiple occasions with neurotoxins and fillers over a period of six years. During this time she reported great improvement in the pain of the affected area, along with an acceptable improvement in the cosmetic appearance of her face. The hope is that in the future, fillers as well as toxins may be utilized in combination to improve and restore the quality of life in people who suffer from similar disfiguring diseases and events.