ABSTRACT
BACKGROUND: The treatment of nonmelanoma skin cancer (NMSC) in the elderly population is a source of significant debate. Mohs micrographic surgery (MMS) is a highly effective treatment option yet not every patient with a cutaneous malignancy that meets appropriate use criteria (AUC) should be treated with surgery. OBJECTIVE: The purpose of this study was to use the Karnofsky Performance Status (KPS) scale to categorize the functional status of patients aged 75 years and older who required treatment of NMSC. The authors wanted to see whether functionality played a role on the treatment selection. METHODS: Patients aged 75 years and older presenting for biopsy of a suspected NMSC that met AUC for MMS were included in the study. Trained medical assistants used the KPS scale to assess patient functionality. Treatment modality was recorded once the biopsy confirmed the NMSC. RESULTS: A cohort of 203 subjects met inclusion criteria for the study. There was a statistically significant difference in utilization of surgical treatments between high and low functionality patients (p = .03). CONCLUSION: Dermatologists consider patient functionality when selecting a treatment for NMSC and use less invasive modalities for patients with poor functional status, even when the tumor meets AUC.
Subject(s)
Karnofsky Performance Status , Skin Neoplasms/therapy , Aged , Aged, 80 and over , Biopsy , Carcinoma, Basal Cell/therapy , Carcinoma, Squamous Cell/therapy , Female , Geriatric Assessment , Humans , Male , Mohs Surgery , Patient Selection , Prospective Studies , United StatesABSTRACT
Bullous pemphigoid (BP) is an acquired, autoimmune, subepidermal blistering disorder. A possible paraneoplastic association has been suggested; however, debate remains regarding the precise relationship of these neoplasms with BP. We present a case of recalcitrant BP in a 67-year-old man with a pancreatic neoplasm that was found to be a lymphoepithelial cyst. Immunoperoxidase staining of the cyst demonstrated C3d along the basement membrane of the stratified squamous epithelium, suggesting that the BP may have involved the lymphoepithelial cyst itself. Shortly after excision of the cyst, BP rapidly resolved without any immunosuppressive treatment, raising the possibility that the immunologic process involving the lymphoepithelial cyst of the pancreas was the inciting factor for the patient's cutaneous disease. Although rare, some cases of BP may be a paraneoplastic process. A thorough screening via patient history and directed laboratory studies may be warranted in recalcitrant cases.
Subject(s)
Pancreatic Cyst/pathology , Pemphigoid, Bullous/pathology , Aged , Basement Membrane/metabolism , Complement C3d/metabolism , Humans , Male , Pancreatic Cyst/complications , Pancreatic Cyst/metabolism , Pancreatic Cyst/surgery , Pemphigoid, Bullous/complications , Pemphigoid, Bullous/diagnosisSubject(s)
Antiviral Agents/adverse effects , Drug Eruptions/etiology , Facial Dermatoses/chemically induced , Hepatitis C, Chronic/drug therapy , Keratosis, Seborrheic/chemically induced , Oligopeptides/adverse effects , Aged , Drug Eruptions/pathology , Facial Dermatoses/pathology , Female , Humans , Interferons/therapeutic use , Keratosis, Seborrheic/pathology , Ribavirin/therapeutic useABSTRACT
Vacuum-assisted delivery has been associated with several complications, including rare vesicular eruptions. Herpes simplex virus has been cultured in a substantial portion of these cases. A case of vesicular eruption from vacuum-assisted delivery is presented in a 1-day-old neonate. The patient was placed on empiric acyclovir until viral cultures and polymerase chain reaction for herpes simplex virus were found to be negative. The lesions resolved without sequelae. The vesicular eruption of vacuum-assisted delivery is probably secondary to mechanical trauma. Clinicians should be aware of the possible risk of herpes simplex virus infection, instituting antiviral therapy until this is excluded.