Spontaneous tumor lysis syndrome in the setting of Candida albicans Fungemia.

Tumor Lysis Syndrome (TLS) is a metabolic emergency seen in patients who receive cytotoxic chemotherapy and can result in significant morbidity and mortality, especially in those patients with high tumor burden. Spontaneous tumor lysis syndrome (STLS) occurs in patients without preceding chemotherapy but may occur in the setting of glucocorticoid administration. We present a case of a 75-year-old male with a history of myelodysplastic syndrome who presented with shortness of breath and developed acute renal failure due to tumor lysis syndrome, likely triggered by candidemia. To our knowledge, this is the first known case of STLS in a patient with high tumor burden who did not receive corticosteroids but likely developed this condition in the setting of infection.

Leprosy: Treatment and management of complications.

In the second article in this continuing medical education series, we review the treatment of leprosy, its immunologic reactions, and important concepts, including disease relapse and drug resistance. A fundamental understanding of the treatment options and management of neuropathic sequelae are essential to reduce disease burden and improve patients' quality of life.

Leprosy: Clinical aspects and diagnostic techniques.

Leprosy, also known as Hansen's disease, is a curable infectious disease that remains endemic in >140 countries around the world. Despite being declared "eliminated" as a global public health problem by the World Health Organization in the year 2000, approximately 200,000 new cases were reported worldwide in 2017. Widespread migration may bring leprosy to nonendemic areas, such as North America. In addition, there are areas in the United States where autochthonous (person-to-person) transmission of leprosy is being reported among Americans without a history of foreign exposure. In the first article in this continuing medical education series, we review leprosy epidemiology, transmission, classification, clinical features, and diagnostic challenges.

Society of Dermatology Hospitalists supportive care guidelines for the management of Stevens-Johnson syndrome/toxic epidermal necrolysis in adults.

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening conditions with high morbidity and mortality. Supportive care management of SJS/TEN is highly variable. A systematic review of the literature was performed by dermatologists, ophthalmologists, intensivists, and gynecologists with expertise in SJS/TEN to generate statements for supportive care guideline development. Members of the Society of Dermatology Hospitalists with expertise in SJS/TEN were invited to participate in a modified, online Delphi-consensus. Participants were administered 9-point Likert scale questionnaires regarding 135 statements. The RAND/UCLA Appropriateness Method was used to evaluate and select proposed statements for guideline inclusion; statements with median ratings of 6.5 to 9 and a disagreement index of ≤1 were included in the guideline. For the final round, the guidelines were appraised by all of the participants. Included are an evidence-based discussion and recommendations for hospital setting and care team, wound care, ocular care, oral care, urogenital care, pain management, infection surveillance, fluid and electrolyte management, nutrition and stress ulcer prophylaxis, airway management, and anticoagulation in adult patients with SJS/TEN.

Treatment of unresectable cutaneous squamous cell carcinoma with pembrolizumab.

Currently, there are few effective therapies for locally advanced and metastatic cutaneous squamous cell carcinoma (cSCC); however, there is recent evidence supporting the use of immunological therapies in cSCC given the typically high mutation burden and association with immunosuppressed states. This report describes a 56-year-old man presenting with synchronous, invasive cSCC on the right temple and right dorsum of the hand deemed unfavourable for surgical resection. The patient was treated with nine infusions of programmed cell death protein 1 (PD-1) inhibitor therapy, pembrolizumab, with clinical and radiographical resolution of his lesions. This case illustrates the potential use of anti-PD-1 antibody as a first-line treatment in the setting of advanced, unresectable cSCC.

Aging in skin of color.

Ethnic skin is quickly emerging as the norm in the United States, and as the population becomes more diverse, there is also a projected rise in the number of aging adults. Given the paucity of data regarding aging in ethnic skin, the authors have consolidated available information for this population. Literature examining structural and functional variation of aging in ethnic skin types was primarily found through PubMed and supplemental textbook chapters. Aging is comprised of two synergistic processes, intrinsic or chronologic aging, and extrinsic aging. Caucasian, African American, East Asian, and Hispanic skin each have distinguishing features of aging, but all populations share dyspigmentation, rhytides, and skin laxity. Increased melanin content predisposes skin of color to a greater degree of hyperpigmentation, but skin thickness may protect against the formation of rhytides. Tailored prevention and treatment are also paramount in attaining favorable outcomes for this growing cohort.

MITF Expression Predicts Therapeutic Vulnerability to p300 Inhibition in Human Melanoma.

Histone modifications, largely regulated by histone acetyltransferases (HAT) and histone deacetylases, have been recognized as major regulatory mechanisms governing human diseases, including cancer. Despite significant effort and recent advances, the mechanism by which the HAT and transcriptional coactivator p300 mediates tumorigenesis remains unclear. Here, we use a genetic and chemical approach to identify the microphthalmia-associated transcription factor (MITF) as a critical downstream target of p300 driving human melanoma growth. Direct transcriptional control of MITF by p300-dependent histone acetylation within proximal gene regulatory regions was coupled to cellular proliferation, suggesting a significant growth regulatory axis. Further analysis revealed forkhead box M1 (FOXM1) as a key effector of the p300-MITF axis driving cell growth that is selectively activated in human melanomas. Targeted chemical inhibition of p300 acetyltransferase activity using a potent and selective catalytic p300/CBP inhibitor demonstrated significant growth inhibitory effects in melanoma cells expressing high levels of MITF. Collectively, these data confirm the critical role of the p300-MITF-FOXM1 axis in melanoma and support p300 as a promising novel epigenetic therapeutic target in human melanoma. SIGNIFICANCE: These results show that MITF is a major downstream target of p300 in human melanoma whose expression is predictive of melanoma response to small-molecule inhibition of p300 HAT activity.

Benign oral mucosal lesions: Clinical and pathological findings.

A diverse spectrum of benign oral mucosal lesions exists, presenting as either isolated oral findings or in association with dermatologic conditions. Oral lesions can closely resemble one another; therefore, it is important for clinicians to be able to recognize their distinctive features, to be able to recognize benign versus malignant disease, and to recognize when obtaining a biopsy specimen is warranted. The first article in this continuing medical education series reviews oral anatomy, the clinical attributes of several benign lesions of the oral cavity, and appropriate management and therapeutic modalities.

Research Techniques Made Simple: Web-Based Survey Research in Dermatology: Conduct and Applications.

Web-based surveys, or e-surveys, are surveys designed and delivered using the internet. The use of these survey tools is becoming increasingly common in medical research. Their advantages are appealing to surveyors because they allow for rapid development and administration of surveys, fast data collection and analysis, low cost, and fewer errors due to manual data entry than telephone or mailed questionnaires. Internet surveys may be used in clinical and academic research settings with improved speed and efficacy of data collection compared with paper or verbal survey modalities. However, limitations such as potentially low response rates, demographic biases, and variations in computer literacy and internet access remain areas of concern. We aim to briefly describe some of the currently available Web-based survey tools, focusing on advantages and limitations to help guide their use and application in dermatologic research.

Peer reviews: the dreaded rejection.

This commentary considers the reasons for rejection of manuscripts during the peer-review process. Poor methodology, inappropriate statistical analysis, irrelevance, and technical errors are cited frequently as motives for manuscript rejection. Guidance, such as selecting an applicable journal, conducting a rigorous study, and writing efficiently, is provided for authors to prevent initial rejection. Researchers are reassured that rejection is a common consequence of peer-review and subsequent submissions to other journals are often successful publications.