Cobimetinib- and vemurafenib-induced granulomatous dermatitis and erythema induratum: A case report.

Metastatic melanoma is an aggressive malignancy. Survival can be increased with the combination of BRAF and MEK inhibition. BRAF inhibitor-induced cutaneous toxicities can be attenuated with MEK inhibition. Here, we describe the first reported case of a patient with metastatic melanoma who developed granulomatous dermatitis and erythema induratum when treated with combination BRAF (vemurafenib) and MEK inhibitor (cobimetinib) therapy and discuss the clinical features and management of dermatologic side-effects secondary to BRAF +/- MEK inhibition.

Acute generalized exanthematous pustulosis induced by hydroxychloroquine: first case report in Canada and review of the literature.

BACKGROUND: Acute generalized exanthematous pustulosis (AGEP) is a rare drug eruption presenting with an acute, extensive formation of nonfollicular sterile pustules on an erythematous and edematous base. Typically, the rash is accompanied by fever and leukocytosis, with spontaneous resolution in < 15 days. The incidence of AGEP is estimated at one to five cases per million people per year. Only 18% of these are from nonantibiotics. Hydroxychloroquine (HCQ) is an antimalarial agent that is also used to treat various dermatologic and rheumatologic conditions. OBJECTIVE: We report the first observation in Canada of a patient with AGEP induced by HCQ. METHODS AND RESULTS: AGEP was diagnosed in a 48-year-old female who had been taking HCQ for 2 weeks and then developed a diffuse erythematous and edematous pustular eruption. Clinical and pathologic findings were consistent with a diagnosis of AGEP. The patient was treated with steroids and supportive measures. The rash resolved after 18 days and a complicated course in hospital. CONCLUSION: AGEP is a rare drug eruption, usually to antibiotics. We report the first case in Canada of AGEP as an adverse reaction to HCQ. Clinicians should keep in mind the possibility of this severe skin eruption.

Agreement between dermatologists and primary care practitioners in the diagnosis of malignant melanoma: review of the literature.

BACKGROUND: The incidence of melanoma continues to rise in the developed world. It is therefore essential for primary care practitioners (PCPs) to be able to discriminate between malignant and benign cutaneous findings, as most patients present to PCPs first for examination of suspicious lesions. OBJECTIVE: To compare dermatologists and PCPs in the diagnosis of malignant melanoma. METHODS: Prospective studies published from January 1950 to August 2010 in MEDLINE, EMBASE, CINAHL, and CancerLit databases were examined. Relevant medical search terms, discussed amongst the authors, were entered into the databases. Only articles comparing dermatologists and PCPs in the diagnosis of malignant melanoma were selected. RESULTS: Dermatologists were reported as having sensitivities, specificities, and diagnostic accuracies ranging from 0.74 to 1.00, 0.56 to 0.95, and 0.85 to 0.89, respectively. PCPs had sensitivities, specificities, and diagnostic accuracies ranging from 0.25 to 0.88, 0.26 to 0.71, and 0.49 to 0.80, respectively. CONCLUSIONS: PCPs should receive more training to improve their ability in the diagnosis of malignant melanoma.

Comparison of dermatologists' and nondermatologists' diagnostic accuracy for malignant melanoma.

BACKGROUND: The incidence of malignant melanoma is increasing annually in Canada and patients present to nondermatologist groups (NDGs) first to have suspicious lesions examined. OBJECTIVE: To determine the ability of Canadian NDGs in the recognition and management of melanoma. METHODS: A survey of 25 malignant and benign skin lesion photographs was distributed to dermatologists and NDGs across Canada. Participants were asked to list whether the lesions were malignant or benign, and could answer 'uncertain' if needed. Dermatologists were subsequently asked if they would biopsy the lesion, whereas NDGs were asked if they would biopsy/refer. RESULTS: Dermatologists achieved mean sensitivities, specificities, and diagnostic accuracies of 0.79, 0.77, and 0.71, respectively. They consistently decided to biopsy malignant lesions. NDGs attained mean scores of 0.61, 0.62, and 0.53, respectively, and selected to refer/biopsy the majority of lesions, malignant and benign. CONCLUSIONS: NDGs should receive more dermatologic training in the recognition of malignant melanoma.

Impact of the number of dermatologists on dermatology biomedical research: a Canadian study.

BACKGROUND: Fewer dermatologists than other clinical specialists are entering and being retained as physicians in the Canadian medical workforce. Studies suggest that dermatologist numbers may influence skin disease outcomes. No study has questioned whether the number of clinical dermatologists can influence academic productivity. OBJECTIVE: To quantify the correlation of the number of dermatologists with biomedical scientific production in this field from 1996 to 2008 in Canada. METHODS: Canadian dermatology biomedical scientific production from SCImago Journal & Country Rank (SJR) were merged with Canadian Medical Association (CMA) dermatologist demographic data. Linear regression analyses were used to model the relationships. RESULTS: The low growth of dermatologist numbers by 8.16% in Canada from 1996 to 2008 correlates with a small increase in articles by 7.59% published in this subject area during this period. This has reduced the scientific importance of Canadian dermatology in the world. CONCLUSION: The number of dermatologists was a significant predictor of biomedical research production in the field of dermatology. This suggests that specialist availability may be one factor influencing dermatology research and publications.

Annular elastolytic giant cell granuloma associated with temporal arteritis leading to blindness.

BACKGROUND: Annular elastolytic giant cell granuloma (AEGCG) is a rare granulomatous disorder characterized by giant cells in the dermis phagocytosing damaged elastin fragments. OBJECTIVE: We report a case of a 71-year-old man presenting with erythematous plaques in predominantly sun-exposed areas. METHOD: A diagnosis of AEGCG was made based on the clinical and histologic picture, and treatment with systemic steroids was initiated. However, while tapering the steroid dose, the patient developed a radiating headache that progressed to temporal arteritis and eventual blindness in the right eye. CONCLUSION: There have been only two previous case reports presenting an association between AEGCG and temporal arteritis. This report explores AEGCG and its possible relationship to temporal arteritis along with possible treatment regimens cited in the current literature.

Teaching dermatology to Canadian undergraduate medical students.

BACKGROUND: The Canadian dermatology undergraduate curriculum was reviewed in 1983, 1987, and 1996. All surveys revealed the limited amount of time dedicated to dermatology in the undergraduate curriculum. OBJECTIVE: This survey was designed to obtain current information regarding undergraduate dermatology teaching in Canadian medical schools. METHODS: A survey was sent electronically to all undergraduate dermatology curriculum coordinators at each of the 17 Canadian medical schools. RESULTS: Between 1996 and 2008, the average number of hours of dermatology teaching has increased by 7 hours to 20.5 ± 17.2 hours. Again, most of the teaching is performed in the preclinical years. The majority of schools would like to have more time dedicated to dermatology teaching; however, many schools cited a restriction in the number of dermatology faculty members, with an average of 7.8 ± 7 dermatologists, as a barrier to education delivery. CONCLUSION: It is important to have dermatology included throughout the undergraduate medical curriculum because most dermatologic problems are seen by nondermatologists. Respondents at each school believed that there may be value in moving toward a national strategy for dermatology curriculum changes, and this can ensure both uniformity and consistency within Canada.