A Unique Case of Metastatic Cutaneous Squamous Cell Carcinoma Presenting Like Carcinoma en Cuirasse on the Face.

Carcinoma en cuirasse (CeC) is a rare case of cutaneous metastases most commonly seen in the breast or visceral organs. The term carcinoma en cuirasse is largely used to describe the coalescing and fibrotic textural changes in the skin that can be seen in these metastatic lesions, which often manifest in a large plaque-like distribution. While most cases of CeC are found on the trunk, CeC has been reported in other body locations. However, to our knowledge, it has not yet been described on the face. In this report, we discuss a rare case of metastatic cutaneous squamous cell carcinoma (cSCC) that presented on the head and neck of a 67-year-old female, for which we have coined the term "carcinoma en bascinet." This novel term stems from the fibrotic changes associated with significant metastatic carcinomas of the head and neck, which bear a resemblance to a bascinet, which is a medieval-style helmet worn by European soldiers during the 14th and 15th centuries. We present this case of carcinoma en bascinet secondary to metastatic cSCC to demonstrate how metastatic cSCC can present in a facial distribution, causing significant morbidity and, as in this case, mortality. We hope that this case will increase the awareness of the highly variable presentation of metastatic cSCC, specifically as an extensive papulonodular and fibrotic plaque, allowing patients to receive early initiation of systemic therapy for symptom management and hence maximizing their quality of life.

Access to consultative dermatologic care via physician-to-physician asynchronous outpatient teledermatology.

OBJECTIVES: To determine whether physician-to-physician outpatient asynchronous store-and-forward teledermatology can be a portal for patient access to consultative dermatologic care and decrease primary care physician referrals to dermatology. STUDY DESIGN: Retrospective study. METHODS: Reviewed outpatient teledermatology consults completed within a shared Epic electronic health record at the University of Pittsburgh Medical Center (UPMC) Health System between August 4, 2013, and December 19, 2019. Study data were reviewed for consult response time and triage percentage. Patient and physician experiences were collected by satisfaction surveys. RESULTS: This study reviewed 1581 teledermatology consults that originated from UPMC primary care provider (PCP) appointments. The average response time for a completed consult was 1 hour, 13 minutes for same-day consult submissions. The majority of consults, 63%, were completed online, whereas only 37% of patients were recommended for an in-person referral visit to the dermatology clinic. Surveyed patients (81%) and PCPs (90%) responded positively to their teledermatology experience. CONCLUSIONS: Physician-to-physician outpatient asynchronous teledermatology consults can provide a model for rapid consultation and decreased primary care referral to dermatology.

Effect of Simple Interrupted Suture Spacing on Aesthetic and Functional Outcomes of Skin Closures.

BACKGROUND: Dermatologic surgeons are trained in fundamental wound closure techniques that minimize wound tension and tissue ischemia to optimize healing and create discrete scars. These include orienting excisions along resting skin tension lines, handling tissue edges with care, and avoiding strangulation while tying suture. Another variable that may affect wound healing and cosmetic outcomes is the spacing between sutures. OBJECTIVE: This prospective, single-centre, randomized, split-scar comparison trial was designed to explore how suture spacing distance affects wound complication rate and scar cosmesis. METHODS: Elliptical surgical wounds of the trunk and extremities were repaired with simple interrupted sutures with varying suture spacing. One half of each wound was repaired with high-density suture spacing (approximately 5 mm apart) and the other with low-density suture spacing (approximately 10 mm apart). Wounds were evaluated at 2-week suture removal for complications, and then reevaluated at 3 and 6 months for cosmesis using the Patient and Observer Scar Assessment Scale score. RESULTS: Results revealed no significant difference in minor wound complications during the early healing process between high- and low-density suture spacing. At 3 months postoperatively, physicians and patients alike preferred the aesthetics of the low-density suture placement. By 6 months postoperatively, this preference disappeared. CONCLUSIONS: These results suggest that suture spacing may affect early scar formation. Additionally, placing sutures farther apart results in fewer total puncture wounds, decreases tissue trauma, and saves surgical time while conserving suture material. Therefore, dermatologic surgeons should consider placing fewer percutaneous sutures during wound repair.

Resident Rounds: Part III--Case Report: Crohn's Disease Presenting as Granulomatous Cheilitis.

Cutaneous Crohn's is a rare extra-intestinal manifestation of inflammatory bowel disease seen in a select group of patients, in which cutaneous lesions similar to those of the intestinal illness appear distant from the gastrointestinal tract. Oral findings may be found in up to 60% of patients with extra-intestinal Crohn's and may appear as the initial symptom underlying disease. We present a case of a 17-year-old male presenting with granulomatous chelitis of the lower lip who was unaware of the underlying diagnosis of Crohn's disease (CD).