Squamoid eccrine ductal carcinoma: clinical, histological and immunohistochemical features.

Squamoid eccrine ductal carcinoma (SEDC) is a cutaneous adnexal malignancy that is histologically challenging to distinguish from squamous cell carcinoma. We report three cases of this rare entity and review the present literature regarding clinical, histological, and immunohistochemical features. Patients presented with a single nodule or plaque lesion on their back and temple. The shave biopsies for Patient A and C were interpreted as SEDC. Patient B's initial shave biopsy was interpreted as probable surface of squamous cell carcinoma, and subsequent excision revealed SEDC. Ductal differentiation was confirmed by positive expression of epithelial membrane antigen and carcinoembryonic antigen immunostains in all three patients. Review of the 67 previously reported cases emphasizes the importance of diagnosing SEDC accurately and promptly given its potential for distant metastasis and mortality. Perineural or lymphatic invasion is associated with higher rate of recurrence or metastasis. There should be high pathologic suspicion for SEDC in an elderly patient presenting with a palpable lesion, even if located outside of the head and neck area, particularly when there is suggestion of ductal differentiation in a sample of a squamous neoplasm.

Evaluating the efficacy of combination and single-agent immunotherapies in real-world patterns of disease progression and survival of metastatic melanoma patients.

The objective of this study is to describe survival outcomes in patients with metastatic melanoma in a real-world setting receiving combination and single-agent immunotherapy outside the clinical trial context. We conducted a retrospective single-institution study of patients with metastatic melanoma in a real-world setting. Survival was calculated using log-rank test. Contingency tables were analyzed using Fisher's Exact test. CD8 + T-cell densities were measured using quantitative immunofluorescence and analyzed using Mann-Whitney U test. The median overall survival (OS) for 132 patients was 45.3 months. Brain metastasis did not confer a higher risk of death relative to liver and/or bone disease (39.53 versus 30.00 months, respectively; P  = 0.687). Anti-PD-1 monotherapy was the most common first-line treatment, received by 49.2% of patients. There was no significant difference in OS between patients receiving single-agent anti-PD-1 and combination anti-PD-1 plus CTLA-4 (39.4 months versus undefined; P  = 0.643). Patients treated with combination therapy were more likely to be alive without progression at the last follow-up than those who received monotherapy (70.4% versus 49.2%; P  = 0.0408). Median OS was 21.8 months after initiation of second-line therapy after anti-PD-1 monotherapy. CD8+ T-cell densities were higher in patients who achieved disease control on first-line immunotherapy ( P  = 0.013). In a real-world setting, patients with metastatic melanoma have excellent survival rates, and treatment benefit can be achieved even after progression on first-line therapy. Combination immunotherapy may produce more favorable long-term outcomes in a real-world setting. High pretreatment CD8+ T-cell infiltration correlates with immunotherapy efficacy.

Nickel release from hairdressing tools in the United States.

BACKGROUND: Hairdressers have a high prevalence of contact dermatitis, especially to nickel. The presence of nickel in hairdressing tools has been evaluated in the European Union, where the government limits nickel release levels from objects. OBJECTIVES: The aim of this study is to qualitatively investigate nickel release in hairdresser tools in both rural and urban United States, a country without nickel release legislation. METHODS: Hairdressers and individuals with hairdressing tools were invited to participate. Metallic parts of each tool were tested with dimethylglyoxime (DMG), which detects nickel release. Data on tool cost were recorded. RESULTS: A total of 89 tools from 9 salons and 2 over-the-counter sets were tested. Twenty-four (27%) tested positive: trimmers (100%), curling irons (100%), clippers (50%), hair clips (36%), texturizing shears (26%), and trimming shears (4%). Nickel was detected in both salon and over-the-counter tools, and rural and urban salons. Nickel-releasing tools were cheaper than DMG-negative tools of the same type. CONCLUSIONS: Our findings help explain the high prevalence of contact dermatitis among hairdressers, alert clinicians to consider occult occupational nickel when assessing patients with allergic contact dermatitis, reinforces the importance of using barrier protection including gloves when handling hairdressing tools including at home, and augments impetus for more legislation regulating common allergens.

Mobile App Usage Among Dermatology Residents in America.

Mobile applications (apps) have been a growing part of medicine for the last decade. Our cross-sectional online survey studied the role of apps in dermatology resident training. The demographic results and response rate suggest that our study sample is representative of the target population of dermatology residents in America. Our survey highlights the increasing role of apps in dermatology resident training, differences in priorities among different years of residency, and differences in information utilization between sexes. This knowledge should help guide standardization, quality assurance, and formal integration of medical mobile apps into traditional dermatology teaching.

Diagnosis and Management of Dermatitis, Including Atopic, Contact, and Hand Eczemas.

This is a comprehensive and current guide for the diagnosis, differential diagnosis, treatment, and management of eczematous dermatitis, with a focus on atopic dermatitis, irritant and allergic contact dermatitis, hand dermatitis including recurrent vesicular and hyperkeratotic types, asteatotic dermatitis, and nummular or discoid dermatitis. Diagnostic options highlighted are clinical history, physical examination, and patch testing. Therapeutic options highlighted are moisturizers, topical corticosteroids, topical calcineurin inhibitors, crisaborole, phototherapy, and systemic medications including biologics.

Evaluating Onychomycosis Outcomes 2 Months into an 11-month-long Efinaconazole Regimen: The Role of Optical Coherence Tomography.

BACKGROUND: Onychomycosis affects 43 million people in the United States and Europe. Topical therapies can be effective but require lengthy and costly regimens without an established method for predicting the treatment outcome. OBJECTIVE: We studied the role of optical coherence tomography (OCT), a noninvasive imaging device approved by the United States Food and Drug Administration, in evaluating onychomycosis treatment outcomes. METHODS: This investigator-initiated prospective clinical study recruited subjects from two urban medical centers. A total of 34 subjects with mild-to-moderate onychomycosis, confirmed using periodic acid-Schiff (PAS) staining, were treated with topical efinaconazole for 48 weeks, at which time a final PAS result was obtained. RESULTS: A positive final PAS result was associated with fungal findings on OCT and with nonclearance of fungal findings by week 12. A negative final PAS was associated with the absence of fungal findings by week 12. OCT findings at Week 8 may suggest a 77% chance of mycological nonclearance or 82% chance of clearance. These predictive values are higher than the currently documented mycological cure rate of 54%. Clinical examination data had no predictive value alone or in concert with OCT. CONCLUSION: We recommend OCT imaging be performed at the end of the second month of treatment to inform shared decision-making regarding whether or not to continue efinaconazole for nine additional months. OCT's ability to evaluate onychomycosis outcome in patients on topical efinaconazole both earlier and more reliably than nonimaging variables may improve the care given to and reduce the cost of onychomycosis for millions of patients.

Cutaneous leishmaniasis successfully treated with miltefosine.

Leishmaniasis is a neglected tropical disease with notable worldwide burden and increasing prevalence in the United States due to globalization. We describe 2 cases of cutaneous leishmaniasis in New England, United States, both caused by the New World subgenus Viannia, in adults returning from Central America. Both patients underutilized preventive measures against bites from phlebotomine sand flies while abroad. They were successfully treated with oral miltefosine, which was well tolerated. Avoidance of vector transmission is the most important preventive measure. Prompt identification and treatment of cutaneous leishmaniasis caused by species with potential for mucocutaneous spread are key to limiting morbidity and mortality. This responsibility should be shared among medical specialties, including dermatologists. Partnering with the Centers for Disease Control and Prevention (CDC) is critical for timely diagnosis and thus treatment. Miltefosine should be considered a first-line agent for cutaneous leishmaniasis given its efficacy, tolerability, availability, and ease of administration. Ondansetron can be prescribed concurrently.

APPlying knowledge: evidence for and regulation of mobile apps for dermatologists.

Although the complexity of health-related applications (apps) has evolved, they have not been adequately regulated or monitored for quality. We review the primary literature behind and regulation of apps that impact dermatologists, with a focus on the 3 most prevalent dermatology-related apps used by dermatology residents in the United States: VisualDx, UpToDate, and Mohs Surgery Appropriate Use Criteria. These apps are widely utilized but have not undergone approval by the 3 main government agencies responsible for regulating mobile medical apps: the US Food and Drug Administration (FDA), Federal Trade Commission, and Office for Civil Rights. Health-related apps that target providers can be a valuable tool, but given their potential impact on human lives, they should be well regulated and evidence based. It is important that apps designed to assist in health care delivery are appropriately monitored and that physicians are aware of the rigor of review of the apps that they choose to use in clinical practice.