Case of eccrine chondroid syringoma of the upper lip.

Chondroid syringoma (CS) is a benign, slow-growing mixed tumour that arises from the sweat glands and usually presents in the head and neck area. Histopathological examination is important for proper diagnosis, as CS is often confused with epidermal cysts due to its rare presentation. This article presents a man in his 40s with a right upper lip mass that emerged 6 months prior to presentation. An intraoral surgical excision was performed and the histopathological analysis revealed solid epithelial cells that formed multiple, non-branching ducts lined by cuboidal epithelium. Cystic spaces were filled by heterogeneous eosinophilic material embedded in chondromyxoid stroma. Histopathology identified the lesion as an eccrine-variant CS. The patient recovered well.

Open Carpal Tunnel Release With a Z-plasty Rearrangement for Median Nerve Mononeuropathy Secondary to Traumatic Scar Contracture.

We present the case of a 56-year-old woman who developed carpal tunnel syndrome and palmar scar contracture secondary to a left-hand palmar laceration in a pedestrian versus motor vehicle accident. The patient underwent carpal tunnel release and a Z-plasty rearrangement to restore normal thumb movement. The patient reported significant improvement in thumb mobility, resolution of median neuropathy symptoms, and no pain along the scar at her three-month follow-up. Our case illustrates the effectiveness of a Z-plasty in relieving tension along scars and potential management for traction-type extraneural neuropathy arising from scar contracture.

Tolerance and efficacy of BRAF plus MEK inhibition in patients with melanoma who previously have received programmed cell death protein 1-based therapy.

BACKGROUND: Combined BRAF and MEK inhibition (BRAF-MEK) is a standard therapy for patients with BRAF V600-mutant melanoma, but to the authors' knowledge, the tolerance, adverse event (AE) profile, and efficacy have not been well defined in the post-programmed cell death protein 1 (PD-1) setting. METHODS: Patients with BRAF V600-mutant melanoma who received combined BRAF-MEK after prior PD-1-based therapy were assembled from 4 tertiary care centers in the United States and Australia. Dose modification was defined as a treatment break, dose reduction, or intermittent dosing. Rates of hospitalization and discontinuation due to AEs were collected, and overall survival (OS) was calculated using Kaplan-Meier methods from the time of the initiation of BRAF-MEK therapy. RESULTS: A total of 78 patients were identified as having received a BRAF-MEK regimen at a median of 34 days after the last dose of PD-1-based therapy. The majority of patients (86%) received the combination of dabrafenib and trametinib. Approximately 80% of patients had American Joint Committee on Cancer M1c or M1d disease. Sixty-five regimens (83%) had ≥1 dose modification. The median time to the first dose modification was 14 days; 86% occurred within 90 days and 71% involved pyrexia. Dose modifications were more common in patients receiving BRAF-MEK <90 days after the last dose of PD-1 and who were not receiving steroids. Of the dose modifications, 25 (31%) led to an AE-related hospitalization. Among 55 BRAF-naive patients, the median time receiving BRAF-MEK therapy was 5.8 months and the median OS was 15.6 months. CONCLUSIONS: The majority of patients receiving BRAF-MEK inhibition after PD-1 therapy require dose interruptions, and a significant minority require hospitalization for AEs. In this higher risk population, the median time receiving therapy and OS may be inferior to those presented in published phase 3 trials.

Novel Technique for Insertion of Cervical Spinal Cord Stimulator Percutaneous Leads: Technical Note and Institutional Experience.

OBJECTIVE: Cervical spinal cord stimulation is a safe and effective treatment for chronic axial neck pain and upper limb neuropathic pain. We report our novel institutional experience with performing cervical spinal cord stimulation trials with patients placed in an upright sitting position. This allows easy access to the cervical epidural space and has the added benefit of unobstructed access to the airway. METHODS: We retrospectively reviewed data for patients who had undergone cervical spinal cord stimulation trial procedures in an upright, sitting position at the Vanderbilt University Medical Center. Demographic information including age, gender, preoperative diagnosis, progression to permanent implant after a successful trial, and operative time in minutes was collected. RESULTS: A detailed description of the technique for implantation of cervical spinal cord stimulator trial leads in an upright sitting position is described. A total of 29 patients were implanted; 16 (55%) were female. Mean operative time was 78 minutes from incision to closing. The majority of patients (25/29; 86%) had successful trials and proceeded to permanent implant. No complications occurred, and the procedure was well tolerated by all patients. CONCLUSIONS: Cervical spinal cord stimulation trials performed in an upright, sitting position allow for easy epidural access and an unobstructed airway with reasonable setup time.

Biomarkers for immune therapy in melanoma.

Immune checkpoint inhibitors have dramatically transformed melanoma treatment options. However, intrinsic and acquired resistance remain fundamental limitations to extending the benefits to all patients. Understanding molecular and clinical features that correlate with response to treatment (biomarkers) may unravel therapeutic resistance, assist in treatment decision-making, and facilitate drug development. An intensive effort to characterize these biomarkers is underway. Herein, we highlight promising molecular biomarkers involving the tumor microenvironment, host immune response, and microbiome. We particularly focus on anti-programmed death-1 (PD-1) therapy but will also briefly cover anti-cytotoxic T lymphocyte antigen-4 (CTLA-4) and novel combination therapies.