Activity Limitation Counseling in Dermatologic Surgery: A Survey and Retrospective Chart Review.

INTRODUCTION: Perioperative counseling regarding activity limitations is critical for patients undergoing dermatologic surgery. Current postoperative instructions regarding activity limitations may be inadequate, but this cannot be determined without knowing patient expectations. The study objective was to elucidate patient expectations for counseling on postoperative activity limitations and to determine if increased counseling would impact patient planning pre or postoperatively. MATERIALS AND METHODS: Patients who had excisions on the neck, torso, or extremities at one institution in one calendar year by the same surgeon participated in a phone survey. Questions addressed preexisting activity level, activity changes after surgery, amount of counseling received, and perioperative counseling expectations. Multivariable logistic regression was used to determine factors associated with patient perceptions about counseling, activity limitations, and surgical outcomes. RESULTS: Patients counseled on postoperative activity limitations reported they were unlikely to have made further arrangements to their surgical/personavl schedule had they been given additional counseling. The inverse was also true. When patients received the amount of counseling they expected, they were less likely to want to reschedule surgery or adjust personal plans. Younger patients and those with surgery on the lower extremities were more likely to limit their activity for longer periods of time. CONCLUSIONS: As instructions on activity limitations become more transparent, patients can make informed decisions regarding their surgical and personal schedules. This study can guide dermatologic surgeons in adjusting postoperative instructions to improve patient understanding of activity limitations, compliance, and the overall quality of their surgical experience.

Squamous Cell Carcinoma With Unusual Benign-Appearing Cystic Features on Histology.

Squamous cell carcinoma (SCC) is a malignancy that arises from keratinocytes of the epidermis. Cystic variants of several types of cutaneous neoplasms have been rarely described in the literature. We report a case of biopsy-proven, well-differentiated invasive SCC treated with Mohs surgery. On frozen sections, the pathology slides showed benign-appearing cystic structures in the margins that persisted after it had appeared that the original malignancy had been cleared. After taking another Mohs stage due to clinical suspicion, additional SCC was found and was subsequently cleared after two more Mohs stages. To the best of our knowledge, this is the first report to histologically demonstrate biopsy-proven invasive SCC with benign-appearing cystic structures on frozen sections.

Squamous cell carcinoma arising in an epidermal inclusion cyst.

Squamous cell carcinoma (SCC) arising from an epidermal inclusion cyst (EIC) is uncommon. We present a case of a 70-year-old man with a scalp nodule with persistent discharge that was resected based on the clinical impression of an EIC. Histopathologic exam showed an infundibular EIC with an epidermal type of squamous epithelium; however, some of the cyst lining and lumen was replaced by squamous proliferation with malignant features. There are 56 cases of SCC arising in EICs reported in the English literature. Though suspected EICs are commonly benign, a thorough pathologic evaluation is required to rule out malignancy.

Perioral volumization using a temperature controlled fractionated radiofrequency device.

BACKGROUND AND AIMS: Cosmetic rejuvenation of the perioral area can be challenging due to a mix of skin laxity and volumetric loss. Current techniques including fillers, neurotoxins, and non-ablative and ablative resurfacing have several drawbacks and can create a stiff, box-shaped, unnatural appearance. Aside from filler, these techniques do not address deeper volume deficiency. Temperature controlled fractionated radiofrequency (FRF) provides consistent formation of new collagen, elastin, and hyaluronic acid. This has been reported to provide long-lasting results for the treatment of skin laxity and volume loss of the face and neck with a single treatment, but it has not been previously reported for perioral rejuvenation. PATIENTS/METHODS: We present a series of seven patients who were treated with perioral FRF, and we assessed their results objectively using a published, validated scale for lower face laxity. RESULTS: All of the patients in this case series showed improvement on the Facial Laxity Rating (FLR) scale after FRF treatment. CONCLUSIONS: This case series represents the first reported use of temperature controlled FRF for perioral rejuvenation. FRF is a promising option for low-risk, natural perioral rejuvenation with long-lasting results and few risks.

Rowell syndrome with recurrence from photoexacerbation: A case report.

Rowell syndrome is a controversial entity composed of erythema multiforme-like lesions coexisting with lupus erythematosus. We describe a case of a 61-year-old male with a history of systemic lupus erythematosus who presented with photoexacerbated flaccid bullae and erosive plaques after repetitive sun exposure. Based on his clinical history, biopsy, and laboratory findings, he fulfilled diagnostic criteria for Rowell syndrome as described by Zeitouni et al. With oral prednisone, hydroxychloroquine, mycophenolate mofetil, and local wound care with petrolatum, the patient's number of lesions decreased, as well as his pain and tenderness. He subsequently did not develop any new erosions. This case highlights the diagnostic criteria of this hybrid clinicopathological syndrome and its nature of photosensitivity.

Case Report of Onychomycosis and Tinea Corporis Due to Microsporum gypseum.

BACKGROUND: Microsporum gypseum is a geophilic dermatophyte that colonises keratinous substances in the soil. Fur-bearing animals carry this dermatophyte but are rarely infected. Human infection can be acquired from the soil, carrier or infected animals, and rarely other humans. M gypseum is an uncommon cause of cutaneous infection in humans and typically manifests as tinea corporis, tinea barbae, and tinea capitis. Onychomycosis is rarely caused by M gypseum. CASE SUMMARY: We present a case of a 32-year-old white man who presented with a red scaly rash and nail dystrophy after adopting a pet rat 10 years prior to presentation. A fungal culture of a nail clipping grew out M gypseum, and the patient was treated with terbinafine daily for 6 weeks for dystrophic onychomycosis and tinea corporis. After the 6 weeks of treatment, the erythema at the proximal nail fold and distal finger had improved but still persisted. An additional 6 weeks of terbinafine daily completely resolved the clinical manifestations of onychomycosis. CONCLUSION: The increase in incidence of M gypseum onychomycosis over the past 2 decades is thought to be due to phylogenetic evolution of the dermatophyte from soil saprophyte to a human parasite. Increasing domestication of mammals is also thought to contribute to increasing incidence. Treatment consists of an extended course of terbinafine or itraconazole.

Identification of Amino Acids at the Catalytic Site of a Ferredoxin-Dependent Cyanobacterial Nitrate Reductase.

An in silico model of the ferredoxin-dependent nitrate reductase from the cyanobacterium Synechococcus sp. PCC 7942, and information about active sites in related enzymes, had identified Cys148, Met149, Met306, Asp163, and Arg351 as amino acids likely to be involved in either nitrate binding, prosthetic group binding, or catalysis. Site-directed mutagenesis was used to alter each of these residues, and differences in enzyme activity and substrate binding of the purified variants were analyzed. In addition, the effects of these replacements on the assembly and properties of the Mo cofactor and [4Fe-4S] centers were investigated using Mo and Fe determinations, coupled with electron paramagnetic resonance spectroscopy. The C148A, M149A, M306A, D163N, and R351Q variants were all inactive with either the physiological electron donor, reduced ferredoxin, or the nonphysiological electron donor, reduced methyl viologen, as the source of electrons, and all exhibited changes in the properties of the Mo cofactor. Charge-conserving D163E and R351K variants were also inactive, suggesting that specific amino acids are required at these two positions. The implications for the role of these five conserved active-site residues in light of these new results and previous structural, spectroscopic, and mutagenesis studies for related periplasmic nitrate reductases are discussed.