Subject(s)
Carcinoma, Merkel Cell , Databases, Factual , Skin Neoplasms , Humans , Carcinoma, Merkel Cell/mortality , Carcinoma, Merkel Cell/epidemiology , Carcinoma, Merkel Cell/pathology , Carcinoma, Merkel Cell/diagnosis , Skin Neoplasms/mortality , Skin Neoplasms/pathology , Skin Neoplasms/epidemiology , Male , Female , Aged , Databases, Factual/statistics & numerical data , Aged, 80 and over , Middle Aged , Cause of DeathSubject(s)
Carcinoma, Basal Cell , Carcinoma, Squamous Cell , Skin Neoplasms , Humans , Skin Neoplasms/surgery , Skin Neoplasms/pathology , Prospective Studies , Male , Carcinoma, Basal Cell/surgery , Carcinoma, Basal Cell/pathology , Female , Carcinoma, Squamous Cell/surgery , Carcinoma, Squamous Cell/pathology , Aged , Middle Aged , Treatment Outcome , Mohs Surgery , Skin Pigmentation , Aged, 80 and overABSTRACT
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.
ABSTRACT
Importance: It has been suggested that Mohs surgery for skin cancer among individuals with limited life expectancy may be associated with needless risk and discomfort, along with increased health care costs. Objective: To investigate patient- and tumor-specific indications considered by clinicians for treatment of nonmelanoma skin cancer in older individuals. Design, Setting, and Participants: This multicenter, prospective cohort study was conducted using data from US private practice and academic centers. Included patients were those older than age 85 years presenting for skin cancer surgery and referred for Mohs surgery, with reference groups of those younger than age 85 years receiving Mohs surgery and those older than age 85 years not receiving Mohs surgery. Data were analyzed from November 2018 through January 2019. Exposures: Mohs surgery for nonmelanoma skin cancer. Main Outcomes and Measures: Reason for treatment selection. Results: Among 1181 patients older than age 85 years referred for Mohs surgery (724 [61.9%] men among 1169 patients with sex data; 681 individuals aged >85 to 88 years [57.9%] among 1176 patients with age data) treated at 22 sites, 1078 patients (91.3%) were treated by Mohs surgery, and 103 patients (8.7%) received alternate treatment. Patients receiving Mohs surgery were more likely to have tumors on the face (738 patients [68.5%] vs 26 patients [25.2%]; P < .001) and nearly 4-fold more likely to have high functional status (614 patients [57.0%] vs 16 patients [15.5%]; P < .001). Of 15 distinct reasons provided by surgeons for opting to proceed with Mohs surgery, the most common were patient desire for treatment with a high cure rate (712 patients [66.0%]), good or excellent patient functional status for age (614 patients [57.0%]), and high risk associated with the tumor based on histology (433 patients [40.2%]). Conclusions and Relevance: This study found that older patients who received Mohs surgery often had high functional status, high-risk tumors, and tumors located on the face. These findings suggest that timely surgical treatment may be appropriate in older patients given that their tumors may be aggressive, painful, disfiguring, and anxiety provoking.
Subject(s)
Carcinoma, Basal Cell , Skin Neoplasms , Aged , Carcinoma, Basal Cell/pathology , Carcinoma, Basal Cell/surgery , Female , Humans , Male , Mohs Surgery , Private Practice , Prospective Studies , Skin/pathology , Skin Neoplasms/pathology , Skin Neoplasms/surgeryABSTRACT
A 52-year-old white man with alcoholic cirrhosis presented to the Mohs surgery clinic with a 1-month history of tender "bumps" located diffusely on his scalp. Two biopsies performed at an outside institution were read as "basal cell carcinoma" and "actinic keratosis." The patient was scheduled for a large excision of the scalp for presumed multiple nodules of basal cell carcinoma and desired a second opinion from our Mohs surgery clinic.
Subject(s)
Carcinoma, Basal Cell/diagnosis , Scalp , Skin Neoplasms/diagnosis , Tinea Capitis/diagnosis , Diagnosis, Differential , Humans , Male , Middle AgedSubject(s)
Anti-Bacterial Agents/administration & dosage , Antibiotic Prophylaxis , Dermatologic Surgical Procedures/adverse effects , Skin Neoplasms/surgery , Surgical Wound Infection/epidemiology , Adolescent , Aged , Aged, 80 and over , Clinical Protocols , Female , Humans , Male , Retrospective Studies , Skin Neoplasms/pathology , Surgical Wound Infection/prevention & controlABSTRACT
Transient lingual papillitis is a benign condition characterized by the inflammation of one or more fungiform papillae on the dorsolateral tongue. Although it is a common condition that affects more than half of the population, few cases have been reported in the dermatological literature. Therefore, it is a condition uncommonly recognized by dermatologists though it has a distinct clinical presentation that may be easily diagnosed by clinicians familiar with the entity. We report an interesting case of transient lingual papillitis in a 27 year-old healthy woman following the consumption of the hard candy, Atomic Fireball. We describe treatment and resolution of the condition, and its recurrence following re-exposure to the identified culprit. This report further reviews the literature to illustrate the clinical manifestations, etiology, differential diagnosis, course, and treatment of this condition.
Subject(s)
Candy/adverse effects , Glossitis/etiology , Adult , Female , Glossitis/diagnosis , Humans , RecurrenceABSTRACT
The development of malignancies in graft donor sites is rare and may be caused by de novo malignancies as well as metastatic and iatrogenic spread. Malignancies in graft donor sites are distinguished from Marjolin ulcers by some investigators because they occur in healed surgical wounds rather than in chronic wounds or unstable scars and tend to occur sooner after injury. We present a unique case of Merkel cell carcinoma (MCC) developing in a vein graft donor site 18 years after vein harvesting.
Subject(s)
Carcinoma, Merkel Cell , Cicatrix , Dissection/methods , Radiotherapy/methods , Skin Neoplasms , Vascular Grafting/adverse effects , Aged , Carcinoma, Merkel Cell/diagnosis , Carcinoma, Merkel Cell/pathology , Carcinoma, Merkel Cell/physiopathology , Carcinoma, Merkel Cell/therapy , Cicatrix/etiology , Cicatrix/pathology , Humans , Male , Neoplasm Staging , Skin Neoplasms/diagnosis , Skin Neoplasms/pathology , Skin Neoplasms/physiopathology , Skin Neoplasms/therapy , Treatment OutcomeABSTRACT
Bullous eruptions in patients with lupus erythematosus can be difficult to diagnose as bullous lesions can develop in lupus-specific lesions, and primary blistering disorders can also occur. Additionally, these patients tend to have multiple co-morbidities making them more likely to be on many medications that can lead to bullous drug reactions. A thorough history, the clinical presentation, and histopathological findings along with direct immunofluorescence can be helpful in diagnosing most cases. The authors report the case of a woman with a long history of systemic lupus erythematosus who initially presented in their clinic for diagnosis and management of erythema dyschromicum perstans and one year later developed bullae in atypical targetoid lesions on the extremities and trunk. They discuss several blistering disorders that have been reported in patients with lupus erythematosus with a focus on features that help distinguish erythema multiforme, fixed drug eruption, and lupus erythematosus from Stevens-Johnson syndrome/toxic epidermal necrolysis. In the patient described herein, the authors favor a diagnosis of Stevens-Johnson syndrome, but the classification between erythema multiforme major and Stevens-Johnson syndrome/toxic epidermal necrolysis cannot be made in some cases.
ABSTRACT
Candidiasis is the most common fungal infection in immunocompromised patients who are at greater risk for developing disseminated disease. Renal transplant recipients often are administered immunosuppressants and therefore are at an increased risk for developing disseminated candidal infections. Disseminated candidiasis generally does not present with cutaneous lesions, but when present, lesions usually are generalized or limited to the trunk and limbs. We describe the case of an immunosuppressed renal transplant recipient who developed a disseminated Candida kefyr infection and presented with oral mucosal lesions and cutaneous lesions limited to the left lower extremity. The lesions were localized due to a thrombus that was subsequently found in the patient's left external iliac artery.