Basal cell carcinoma stroma as a mimicker of lymphatic invasion: A case report.

Basal cell carcinoma metastases are rare. We report a case of an 83 year-old male with recurrent cutaneous infiltrative basal cell carcinoma on the right vertex with tumor aggregates of infiltrative basal cell carcinoma in the lymphatic vessels of the superficial dermis strongly suspected on pathology slide evaluation during Mohs micrographic surgery. D2-40 immunohistochemical stain allows the detection of lymphatic invasion by highlighting endothelial cells. Further histologic review and D2-40 stains performed on the paraffin-embedded sections did not reveal an endothelial cell lining in favor of lymphatic invasion. What was identified as lymphatic invasion was the result of a peculiar basal cell carcinoma stroma. Correct identification of basal cell carcinoma stroma as a mimicker of lymphatic invasion would prevent potentially invasive investigation as well as associated costs. This is of great importance as the prognostic and therapeutic implications can be of significant value for the patient.

Unusual use of a common skin flap for a large cutaneous defect following Mohs surgery for lentigo maligna of the cheek: A case report.

The bilobed flap is most often used for the reconstruction of small cutaneous defect of the nose. Under certain circumstances, it can also be useful in the reconstruction of much larger defects of the face. Our objective is to report a case of bilobed flap reconstruction in a patient with a large defect of the zygomatic cheek following a Mohs micrographic surgery for lentigo maligna.

Skin cancer screening after solid organ transplantation: Survey of practices in Canada.

Guidelines recommend annual dermatology screening after solid organ transplantation to facilitate early detection of keratinocyte carcinoma (nonmelanoma skin cancer), the most common posttransplant malignancy. There are limited data on adherence levels and barriers to screening. We conducted a cross-sectional survey of 477 physicians and nurses providing posttransplant care in Canada. The questionnaire asked about skin cancer screening and education practices, including the perceived importance and barriers. Whereas care providers viewed skin cancer screening as important for adult patients (median rating of 10/10, interquartile range 8-10), only 53% ensured annual screening for white adult transplant recipients. Having a screening policy in place (adjusted odds ratio 6.78, 95% confidence interval 3.12-14.74) and a dermatologist present at the transplant center (adjusted odds ratio 2.19, 95% confidence interval 1.03-4.67) were independently associated with higher adherence. Long wait times, lack of specialized transplant dermatologists, long travel distances, and insufficient priority were cited as the most common barriers for access to dermatologic care. Skin cancer education was provided to patients by over three quarters of care providers. Given the self-reported lack of adherence to annual skin cancer screening, there is need to develop, evaluate, and implement interventions that improve screening rates and skin cancer outcomes.

Variable response of post-Mohs surgery telangiectasias to KTP laser: A case report.

A common but under-recognized complication of Mohs micrographic surgery is the development of surgical site telangiectasias after repair. Treatment with pulsed dye laser has shown good results in treating periscar telangiectasias, while treatment with KTP laser has never been studied for this complication. We report the findings in six patients with persistent telangiectasias post-Mohs micrographic surgery and their response to treatment with KTP laser. After one treatment with KTP laser, the severity of telangiectasias, scar erythema, and patient and physician-rated improvement were recorded. Response to KTP laser was variable. However, this case series suggests that KTP laser may have the potential to improve the appearance of periscar telangiectasia after Mohs micrographic surgery.

Multifocal ulceronecrotic skin lesions-A stigmatizing case.

Mycobacterium chelonae is a rapidly growing nontuberculous mycobacteria, ubiquitous in the environment and mostly involved in skin, soft tissue and bone infections. An atypical, severe and multifocal dermatological manifestation of Mycobacterium chelonae infection in an immunocompetent patient is described here. The lesions completely resolved using a multidisciplinary approach. This case emphasizes the important aspects of diagnosis, antimicrobial and surgical management.

Treatment of Palmar Hyperhidrosis With Needle Injection Versus Low-Pressure Needle-Free Jet Injection of OnabotulinumtoxinA: An Open-Label Prospective Study.

BACKGROUND: OnabotulinumtoxinA (OnabotA) injections are effective to treat palmar hyperhidrosis (HH) but are quite painful. OBJECTIVE: To evaluate efficacy and pain of OnabotA injection using a needle-free jet apparatus compared with the traditional needle injection to treat palmar HH. METHODS: Twenty patients were recruited for a prospective open-label study. Their right hand was injected with 1% lidocaine with a jet injector, after which OnabotA was injected with a needle. The left hand was injected with OnabotA directly using the jet injector. Pain scores were recorded for both techniques. At 0, 1, 3, and 6 months, severity of palmar HH was evaluated with the Hyperhidrosis Disease Severity Scale (HDSS). RESULTS: One point reduction in the HDSS score at 1 month showed no statistical difference between both hands (p = .451). However, the HDSS score at 1 month from baseline dropped by 1.6 for the hand treated with traditional needle injection of OnabotA compared with 1.25 for the hand treated with jet injections (p = .031). There was no statistical difference in the pain on injection with both techniques (p = .1925). CONCLUSION: This study demonstrates effective and relatively painless use of a low-pressure jet injector for OnabotA in palmar HH.

Dermatologic Surgical Pearls: Enhancing the Efficacy of the Traditional Elliptical Excision.

Dermatologic surgery procedures can sometimes be time consuming in an office setting. We present a series of tips for dermatologists and dermatologic surgeons that will enhance the efficiency of simple procedures.

Dermatologic Surgical Pearls Part 4: Tips for Full-Thickness Skin Grafts.

Dermatologic surgery procedures can sometimes be time consuming in an office setting. We present a series of tips for dermatologists and dermatologic surgeons that will enhance the efficiency of skin graft procedures.

Dermatologic Surgical Pearls Part 3: Tips for Labial Excisions and Repairs.

Dermatologic surgery procedures can sometimes be time consuming in an office setting. We present two tips for dermatologists and dermatologic surgeons that will enhance the efficiency of procedures around the lip.

Dermatologic Surgical Pearls: Tips for Closing a Defect under Tension.

Dermatologic surgery procedures can sometimes be time consuming in an office setting. We present a series of tips for dermatologists and dermatologic surgeons that will enhance the efficiency of simple procedures. This article reviews three methods to aid in the closure of defects under tension.

Treatment of nail psoriasis with intralesional triamcinolone acetonide using a needle-free jet injector: a prospective trial.

BACKGROUND: Treating nail psoriasis is challenging. Corticosteroid matrix injection with needle is a conventional treatment but pain is often a limitation. OBJECTIVE: Evaluate efficacy and safety of triamcinolone acetonide needle-free injection with the Med-Jet MBX in psoriatic fingernail. METHODS: Seventeen patients were enrolled between January 2012 and January 2013. Four treatments sessions were scheduled every 4 ± 1 weeks. Clinical efficacy was evaluated according to Nail Psoriasis Severity Index (NAPSI) score of target nail differences before and after the treatment. RESULTS: Mean baseline NAPSI score was 6.5 on an 8-point scale (95% confidence interval [CI] 5.652-7.348) and mean final NAPSI score was 2.8 on an 8-point scale (95% CI 1.859-3.741), demonstrating statistically significant treatment efficacy (p = .0007). NAPSI score for target nail from baseline to end of treatment was decreased by 46.25%. CONCLUSION: Treatment with triamcinolone acetonide delivered by Med-Jet MBX is a safe, minimally painful and effective treatment for nail psoriasis.

Anterior segment changes after pilocarpine and laser iridotomy for primary angle-closure suspects with Scheimpflug photography.

PURPOSE: To assess changes in Scheimpflug-based measurements of the anterior segment after pilocarpine administration and prophylactic laser peripheral iridotomy in narrow anterior chamber angles. METHODS: Thirty-seven eyes in 37 patients with occludable angles were included in this prospective interventional case series. Primary angle-closure suspects (iridotrabecular contact in 3 quadrants or more) were enrolled. Patient evaluation included indentation gonioscopy, Goldmann tonometry, and optic nerve examination. The mean of 3 consecutive Pentacam measurements was taken at baseline, 45 minutes after 2% pilocarpine administration, and 1 month after laser peripheral iridotomy (LPI). Anterior chamber angle (ACA), anterior chamber volume (ACV), anterior chamber depth (ACD), pupil diameter, central corneal thickness, and intraocular pressure were measured. RESULTS: ACV increased significantly after LPI (from a mean ± standard error of 94.6 ± 3.6 mm(3) to 108.8 ± 3.4 mm(3), P<0.001), as did the ACA (26.7 ± 0.9 degrees to 28.2 ± 0.8 degrees, P<0.001). Central corneal thickness decreased significantly after LPI (558.1 ± 5.3 µm to 552.6 ± 5.7 µm, P=0.018). Central ACD increased slightly after LPI, but this was not statistically significant (2.13 ± 0.05 mm to 2.15 ± 0.05 mm, P=0.109). Pupil diameter and intraocular pressure also did not change significantly after LPI. After pilocarpine, the ACV decreased significantly (by 4.3 ± 1.3 mm(3), P=0.009), as did the central ACD (by 0.1 ±0.02 mm, P<0.001) and the pupil diameter (by 0.74 ± 0.06 mm, P<0.001). CONCLUSIONS: Scheimpflug photography demonstrates significant anterior segment changes after pilocarpine and after LPI in primary angle-closure suspects.

Childhood linear IgA bullous disease induced by trimethoprim-sulfamethoxazole.

BACKGROUND: Linear IgA bullous disease (LABD) is a rare mucocutaneous autoimmune subepidermal blistering disease that can affect children mostly of pre-school age. As many as two-thirds of LABD are related to drug ingestion, particularly certain antibiotics, non-steroidal anti-inflammatory drugs and diuretics. MAIN OBSERVATION: We describe a 3-year-old boy who presented a CMV infection followed by LABD induced by trimtheporim-sulfametoxazole. To our knowledge, this is the first reported case of trimethoprim-sulfamethoxazole that was confirmed by a rechallenge. CONCLUSIONS: Most cases of drug-induced LABD are patients being treated with multiple systemic drugs that could induce the LABD. In the lack of suitable alternative treatment, the identification of the causative drug can be achieved by a rechallenge under close medical surveillance.