Prospective study of pigmented lesions managed by shave excision with no deep margin transection of melanomas.

Shave excision is a simple and cost-effective technique for the removal of suitable skin lesions. We performed a prospective study over six months, collecting data from pigmented lesions that were treated with shave excision by dermatologists. Only shave excisions with the intent to remove the lesion in toto were included. A total of 349 lesions were included in this study, 50 (14%) of these were melanomas and no melanoma diagnosed had deep margin involvement, while 13 (26%) had lateral margin involvement.

Cutaneous pemphigus vulgaris with absence of desmoglein 1 autoantibodies. An example of the extended desmoglein compensation theory.

A 79 year-old male patient presented clinically as a typical case of pemphigus foliaceus. He displayed a seborrhoeic pattern of crusting and erosions with an absence of oral involvement. Surprisingly, a biopsy showed suprabasilar acantholysis and direct immunofluorescence consistent with pemphigus vulgaris. Indirect pemphigus antibodies were positive for desmoglein 3 (DSG-3) but negative for DSG-1 antibodies. Most cases of cutaneous pemphigus are reported to have both DSG-1 and DSG-3 antibodies. A rare cutaneous subtype of pemphigus vulgaris is reported in the literature that may present clinically as seen in our patient. Our patient is clinically similar to these previous reported cases but with a negative DSG-1 antibody titre. The extended DSG compensation theory explains the differences of clinical expression in pemphigus based on the variable pathogenicity of DSG antibodies as well as the distribution of DSG-1 and DSG-3. We discuss this case, highlighting the theories of the pathogenesis of pemphigus and, in particular, the cutaneous pemphigus subtype.

Patch testing for allergic contact dermatitis to cigarettes: smoked/unsmoked components and formaldehyde factors.

A patient with hand dermatitis reported that switching her smoking hand resulted in reduced symptoms. When allergy to cigarettes is suspected the literature supports standard allergy testing as well as testing the individual components of cigarettes. Initial standard patch testing revealed an allergy to formaldehyde and the formaldehyde releasing agent, quaternium-15. The patient did not react to her usual roll-your-own cigarette components but reacted to the smoked filter paper of a particular brand of cigarette she frequently borrowed from a friend. Possible explanations include either a variation of ingredients between cigarettes that alters the formaldehyde concentration or another unidentified allergen in the branded cigarette causing allergic contact dermatitis.