Diagnostic accuracy of high-frequency ultrasound for cutaneous neoplasms: a narrative review of the literature.

High-frequency ultrasound has been used to visualize depth and vascularization of cutaneous neoplasms, but little has been synthesized as a review for a robust level of evidence about the diagnostic accuracy of high-frequency ultrasound in dermatology. A narrative review of the PubMed database was performed to establish the correlation between ultrasound findings and histopathologic/dermoscopic findings for cutaneous neoplasms. Articles were divided into the following four categories: melanocytic, keratinocytic/epidermal, appendageal, and soft tissue/neural neoplasms. Review of the literature revealed that ultrasound findings and histopathology findings were strongly correlated regarding the depth of a cutaneous neoplasm. Morphological characteristics were correlated primarily in soft tissue/neural neoplasms. Overall, there is a paucity of literature on the correlation between high-frequency ultrasound and histopathology of cutaneous neoplasms. Further studies are needed to investigate this correlation in various dermatologic conditions.

Cutaneous Leishmania aethiopica diagnosed in the United States.

Cutaneous leishmaniasis is a parasitic infection caused by certain Leishmania spp and is endemic in the New world (Central and South America) and Old World (Africa and the Middle East) where it is transmitted via sandflies of the Phlebotomus and Lutzomyia species. We describe a case of a 61-year-old woman who presented with an asymptomatic red-brown papule on her lower back approximately one year after returning to the United States from a trip to Ethiopia and Cameroon. Polymerase chain reaction was performed on the biopsy material and identified Leishmania aethiopica. This case highlights an atypical location and demonstrates how to accurately diagnose and treat this parasitic infection.

Anogenital syringocystadenocarcinoma papilliferum in situ or anaplastic extramammary Paget disease? A unifying concept and review of the literature.

Extramammary Paget disease (EMPD) is a rare cutaneous malignancy that typically involves the genital skin and can be primary or associated with an underlying internal malignancy. The typical histopathological appearance of EMPD consists of single or small aggregates of cells with abundant pale cytoplasm and large pleomorphic nuclei, known as Paget cells, scattered throughout the epidermis. We report a case of anogenital EMPD occurring in a 53-year-old man with unusual histopathologic findings of marked epidermal acanthosis, acantholysis, intraepidermal glandular differentiation, and prominent plasma cell-rich fibrovascular cores. These features were entirely confined to the epidermis and adnexa with no evidence of dermal invasion or underlying systemic disease. We review and summarize the literature for atypical features noted in EMPD and summarize similar findings previously described under a variety of descriptions including anaplastic EMPD, anogenital syringocystadenocarcinoma papilliferum in situ (SCACPIS), SCACPIS-like changes in EMPD, and EMPD mimicking acantholytic squamous cell carcinoma in situ. We propose that these features represent a single entity and be considered under a unifying diagnosis to facilitate recognition of this entity.

Synthesis and crystal structures of some bis(3-methyl-1H-indol-2-yl)(salicyl)methanes.

Four 2,2'-bisindolylmethanes (BIMs), a useful class of polyindolyl species joined to a central carbon, were synthesized using salicylaldehyde derivatives and simple acid catalysis; these are 2-[bis(3-methyl-1H-indol-2-yl)methyl]-6-methylphenol, (IIa), 2-[bis(3-methyl-1H-indol-2-yl)methyl]-4,6-dichlorophenol, (IIb), 2-[bis(3-methyl-1H-indol-2-yl)methyl]-4-nitrophenol, (IIc), and 2-[bis(3-methyl-1H-indol-2-yl)methyl]-4,6-di-tert-butylphenol, (IId). BIMs (IIa) and (IIb) were characterized crystallographically as the dimethyl sulfoxide (DMSO) disolvates, i.e. C26H24N2O·2C2H6OS and C25H20Cl2N2O·2C2H6OS, respectively. Both form strikingly similar one-dimensional hydrogen-bonding chain motifs with the DMSO solvent molecules. BIM (IIa) packs into double layers of chains whose orientations alternate every double layer, while (IIb) forms more simply packed chains along the a axis. BIM (IIa) has a remarkably long c axis.

A case of segmental Darier disease treated with doxycycline monotherapy.

Darier disease is a rare autosomal dominant disorder that results from a mutation in the gene coding for the endoplasmic reticulum membrane calcium pump Ca2+-ATPase type 2 (SERCA2), leading to compromised intercellular adhesion. Patients typically present in the first two decades of life with keratotic, greasy papules in a seborrheic distribution. Segmental Darier disease is a variant with localized disease that follows Blaschko lines. Treatment options include topical and systemic agents including corticosteroids, retinoids, and antibiotics. We present a 67-year-old woman who came to our clinic with segmental Darier disease recalcitrant to topical therapy. Owing to cost and side effect profile, the patient declined treatment with oral retinoids. Doxycycline 100mg daily was started with significant improvement. Tetracyclines both chelate and assist calcium to cross membranes. This mechanism may correct the cellular calcium imbalance present in Darier disease. In addition, tetracyclines have been shown to inhibit metalloproteinase 9, an important part of Darier disease pathogenesis. Owing to its favorable side effect profile, further investigation is warranted to establish doxycycline as a more widely utilized treatment option for Darier disease.

Assessment of medical students' proficiency in dermatology: Are medical students adequately prepared to diagnose and treat common dermatologic conditions in the United States?

This study assessed whether a current medical school curriculum is adequately preparing medical students to diagnose and treat common dermatologic conditions. A 15-item anonymous multiple choice quiz covering fifteen diseases was developed to test students' ability to diagnose and treat common dermatologic conditions. The quiz also contained five items that assessed students' confidence in their ability to diagnose common dermatologic conditions, their perception of whether they were receiving adequate training in dermatology, and their preferences for additional training in dermatology. The survey was performed in 2014, and was completed by 85 students (79.4%). Many students (87.6%) felt that they received inadequate training in dermatology during medical school. On average, students scored 46.6% on the 15-item quiz. Proficiency at the medical school where the study was performed is considered an overall score of greater than or equal to 70.0%. Students received an average score of 49.9% on the diagnostic items and an average score of 43.2% on the treatment items. The findings of this study suggest that United States medical schools should consider testing their students and assessing whether they are being adequately trained in dermatology. Then schools can decide if they need to re-evaluate the timing and delivery of their current dermatology curriculum, or whether additional curriculum hours or clinical rotations should be assigned for dermatologic training.

Medical students with low self-efficacy bolstered by calling to medical speciality.

This study was performed to understand the degree to which medical students' self-efficacy (SE) moderates the influence of calling on students' speciality commitment, emphasizing the need to understand variables that predict primary care specialization. The researchers hypothesized that students who perceived their career as a calling would be more committed to their speciality, especially when students had high SE. Medical students (Years 1-4; N = 152) completed an online survey to rate their calling, speciality commitment, and SE. Calling was measured by the Brief Calling scale (Dik et al., J Career Assess 20:242-263, 2012), while speciality choice was measured by Hollenbeck et al. (J Appl Psychol 74:18-23, 1989) measure of commitment. SE was measured by the Jerusalem and Schwarzer's general SE scale (see Scholz et al., Eur J Psychol Assess 18:242-51, 2002). Calling (r = 0.24, p < 0.01) and SE (r = 0.20, p < 0.05) were found to moderately correlate with speciality commitment, thus emphasizing the possibility that they may have an interaction. The interaction of calling and SE significantly predicted speciality commitment (ß = -0.20, t(148) = -2.55, p < 0.05) and explained a significant proportion of variance in speciality commitment (R (2) = 0.12, F(3, 148) = 6.875, p < 0.001). Students with a high presence of calling may have high speciality commitment, despite low SE.

Herpes zoster in a 2-year-old vaccinated against varicella.

Herpes zoster is uncommon in the pediatric population. We report a case of herpes zoster in a 2-year-old boy who received the live attenuated varicella zoster virus vaccination at his 12-month pediatric visit. The child was treated with acyclovir and recovered without complications.

Fish odor syndrome: a case report of trimethylaminuria.

Trimethylaminuria is a rare, autosomal recessive, metabolic disorder that results in accumulation of trimethylamine (TMA), which smells like rotten fish. The chemical is excreted in sweat and urine owing to a deficiency in the enzyme flavin monooxygenase 3 (FMO3). We report a case of trimethylaminuria in a 12-year-old girl. The patient failed treatment with diet and hygiene modification, but achieved symptomatic improvement after a four-month course of metronidazole.