Gastric carcinoma's primary presentation as multiple cutaneous nodules throughout the body.

Cutaneous metastasis resulting from internal primary tumors remains a rare phenomenon. The prompt recognition of these metastases is important, as they are an indicator of advanced disease and poor prognosis. We report the case of a 44-year-old Caucasian man presenting with a four-month history of multiple cutaneous nodules on the face, trunk, and upper extremities. Results from skin biopsy revealed strands and cords of atypical cells concerning for poorly differentiated metastatic carcinoma. An esophagogastroduodenoscopy was performed and a poorly differentiated signet-ring type invasive adenocarcinoma at the lesser curvature of the stomach was found. As the cancer had already metastasized to the skin and bones, the patient was started on chemotherapy with an oxaliplatin-based regimen and denosumab for the bone metastases, with resultant objective response and diagnostic control for greater than one year to the present date.

Basal Cell Carcinoma in the Nasal Vestibule.

Basal Cell Carcinoma (BCC) is one of the most common human malignant neoplasms and is the most prevalent skin cancer in the United States with over four million new cases reported annually.1,2 Most BCCs arise in the skin from exposure to the sun’s ultraviolet radiation. However, it is possible for BCCs to present in sun-protected areas due to factors other than sun exposure. We present a case of a basal cell carcinoma located in the nasal vestibule. In presenting this case, we would like to emphasize the importance of attentive full skin examinations, both by physicians and patients, that include observation of sun-protected areas, as skin cancers such as basal cell carcinomas may occur in these unusual areas. In addition, BCCs have been reported in the literature to have occurred in the interdigital area of the foot, the female and male nipples, the axillae, and the genital and perianal areas.3,4,5,6,7,8 J Drugs Dermatol. 2020;19(3):333-334 doi:10.36849/JDD.2020.4517.

Utilization of a new tissue expander in the closure of a large Mohs surgical defect.

BACKGROUND: Malignant proliferating trichilemmal tumor (MPTT) is a rare neoplasm originating in the outer sheath of a hair follicle that often presents as a slowly enlarging, painful, subcutaneous scalp nodule. The authors describe a case of malignant proliferating trichilemmal tumor (MPTT) in an elderly 65-year-old Asian male who presented with a 5.5 x 5.0 cm mass on the posterior scalp. METHODS: The authors present a unique dual approach to treatment of MPTT in both the excision and wound revision phases. First, Mohs micrographic surgery is utilized for more discrete removal of malignant tissue, as opposed to wide excision. Then, a novel device called DermaClose RC is used in wound revision, a device that has proven to be more effective in promoting wound closure than traditional suturing. RESULTS: Mohs micrographic surgery was used to excise the tumor in three stages. The resulting irregular wound measured 6.3 x 5.6 cm, and was repaired with the device. Following the application of the device, the wound reduced in size to 1.5-1.0 cm. Postoperatively, the patient had no evidence of recurrent disease at seven months. CONCLUSION: Use of the DermaClose RC tissue expander following a Mohs surgical procedure provides an effective functional and cosmetic alternative to a skin graft which creates a donor site wound and creates a more complicated, time consuming procedure. The dual approach discussed here-of Mohs micrographic surgery performed in tandem with wound revision via the tissue expanding device is one that may yield promising benefits but warrants further evaluation.