Squamous cell carcinoma originating from cutaneous cysts: The Henry Ford Experience and review of the literature.

PURPOSE: Malignant transformation to squamous cell carcinoma (SCC) arising within cutaneous epidermal cysts is a very rare phenomenon. We provide a series of new cases and an overview of the literature. We sought to define the prevalence of and characterize SCC arising within epidermal and pilar cysts. PATIENT AND METHODS: We searched Henry Ford Health System (HFHS) non-melanoma skin cancer (NMSC) registry from 2005 to 2009 to identify cases of SCC arising from epidermal cysts. RESULTS: We identified 1904 cases of epidermal cysts at our institution between 2005 and 2014. Of these, three cases of SCC arose from an epidermal cyst and one case of SCC developed from a pilar cyst. All lesions occurred below the waist with the exception of the pilar cyst on the scalp. CONCLUSIONS: Given the extremely low incidence, propensity of malignant lesions to become symptomatic and efficacy of treatment, we do not recommend routine excision of all epidermal cysts. Instead, we recommend excision and pathology for all symptomatic epidermal cysts, or those that rapidly grow, or do not respond to medical therapy.

Role of oral Polypodium leucotomos extract in dermatologic diseases: a review of the literature.

Polypodium leucotomos extract (PLE), derived from the tropical fern of Polypodiaceae family, has properties ranging from immunomodulatory and antioxidative to photoprotective. It is these multiple mechanisms of action, in combination with a favorable side effect profile, which makes PLE a promising adjunctive treatment for several dermatologic disorders. Studies are summarized on the use and potential applications of PLE in the treatment or management of photodermatoses, vitiligo, melasma, psoriasis, atopic dermatitis, and more recently, in minimizing infections in high-performance athletes. More data, however, with larger sample sizes are needed to confirm these benefits.

Heparin-induced bullous hemorrhagic dermatosis.

Unfractionated heparin (UFH) and low-molecular-weight heparin (LMWH) have been used for years in the prophylaxis and treatment of thromboembolic disease. Cutaneous reactions to heparin include hematomas, ecchymoses, erythematous plaques, nodules, skin necrosis, contact dermatitis, and urticaria, all occurring more commonly at local subcutaneous injection sites. Generalized cutaneous reactions are more rare. We report the case of a man with no known risk factors who developed intraepidermal hemorrhagic bullae on distant sites after receiving intravenous UFH for suspected pulmonary embolism. He was diagnosed with heparin-induced bullous hemorrhagic dermatosis and recovered without further complications after discontinuation of the heparin. This case reveals that widespread cutaneous reactions to heparin may occur, though they are rare.

State medical board regulation of minimally invasive cosmetic procedures.

BACKGROUND: There is little information regarding commonalities, differences, and trends in the regulation of minimally invasive cosmetic procedures (MICP) across different state medical boards in the United States. OBJECTIVE: We sought to assess current state medical board regulations regarding MICP, so as to better understand current and emerging trends in rules regarding delegation, and management of patient complaints. METHODS: We conducted structured interviews with officials at US allopathic medical boards, supplemented with information from board World Wide Web sites. RESULTS: A total of 31 (62%) boards participated. Most (20 boards; 63% of total respondents) reported that all MICP can be delegated at the physician's discretion and responsibility to at least one category of nonphysician; 7 states were expecting changes in delegation rules; and 4 states had very specific delegation requirements. Approximately equal numbers of boards required some general supervision of nonphysicians (14, 45%), or required some type of on-site supervision (13, 42%); a small number explicitly permitted off-site supervision (4, 13%). There was variation in the number of physician assistants one physician could supervise. Most boards (15 states) required some type of mandatory reporting, but not necessarily of incidents involving MICP. Very few (4) required reporting of both office- and nonoffice-based MICP incidents. Western states had liberal delegation and supervision requirements; these requirements were more stringent in Southern states. LIMITATIONS: Not all boards participated in this study. CONCLUSION: There is substantial variation in board regulation of MICP. Many boards are promulgating new rules. Medical boards also have limited ability to regulate nonphysicians.