Assuntos
Adenocarcinoma Sebáceo , Neoplasias das Glândulas Sebáceas , Neoplasias Cutâneas , Humanos , Queratina-7 , Cirurgia de Mohs , Adenocarcinoma Sebáceo/cirurgia , Adenocarcinoma Sebáceo/patologia , Neoplasias Cutâneas/cirurgia , Neoplasias Cutâneas/patologia , Neoplasias das Glândulas Sebáceas/cirurgia , Neoplasias das Glândulas Sebáceas/patologiaRESUMO
BACKGROUND: PReferentially expressed Antigen in MElanoma (PRAME) immunohistochemical (IHC) staining is used to aid melanoma diagnosis. PRAME expression in nevus-associated melanoma (NAM) has not been evaluated. METHODS: PRAME IHC was applied to cases of NAM; staining for each population of melanocytes (benign and malignant) was graded based on the percentage of labeled cells. No labeling was graded 0, 1% to 25% labeling was 1+, 26% to 50% was 2+, 51% to 75% was 3+, and >76% was 4+. RESULTS: Thirty-six cases were reviewed. Sixty-seven percent (24/36) of melanomas were PRAME positive (4+) while no (0/36) nevi showed 4+ positivity. Eighty-one percent (29/36) of nevi were completely PRAME negative compared to 17% (6/36) of melanomas. In 67% of cases (24/36) PRAME differentiated between benign and malignant melanocyte populations. CONCLUSIONS: We identified a high rate (67%) of differential PRAME staining in adjacent benign and malignant melanocyte populations in NAM. In PRAME positive (4+) melanomas, PRAME differentiates 100% (24/24) of benign and malignant melanocyte populations. When 4+ staining is used as the threshold for positivity, PRAME staining has a sensitivity of 67% (24/36) and a specificity of 100% (36/36). These results support PRAME IHC can assist in distinguishing melanocyte populations in melanoma arising within nevi.
Assuntos
Antígenos de Neoplasias/metabolismo , Transformação Celular Neoplásica/patologia , Nevo Pigmentado/diagnóstico , Nevo Pigmentado/metabolismo , Neoplasias Cutâneas/patologia , Biópsia/métodos , Diagnóstico Diferencial , Humanos , Imuno-Histoquímica/métodos , Incidência , Melanócitos/patologia , Melanoma/epidemiologia , Melanoma/metabolismo , Melanoma/patologia , Gradação de Tumores/métodos , Nevo/epidemiologia , Nevo/metabolismo , Nevo/patologia , Nevo Pigmentado/epidemiologia , Prevalência , Sensibilidade e Especificidade , Coloração e Rotulagem/métodosRESUMO
BACKGROUND: The American Academy of Dermatology recommends dermatologists understand the costs of dermatologic care. OBJECTIVE: This study sought to measure dermatology providers' understanding of the cost of dermatologic care and how those costs are communicated to patients. We also aimed to understand the perspectives of patients and dermatological trainees on how cost information enters into the care they receive or provide. METHODS: Surveys were systematically developed and distributed to 3 study populations: dermatology providers, residents, and patients. RESULTS: Response rates were over 95% in all 3 populations. Dermatology providers and residents consistently underestimated the costs of commonly recommended dermatologic medications but accurately predicted the cost of common dermatologic procedures. Dermatology patients preferred to know the cost of procedures and medications, even when covered by insurance. In this population, the costs of dermatologic medications frequently interfered with patients' ability to properly adhere to prescribed regimens. LIMITATIONS: The surveyed population was limited to the northwestern United States and findings may not be generalizable. Cost estimations were based on average reimbursement rates, which vary by insurer. CONCLUSION: Improving dermatology providers' awareness and communication of the costs of dermatologic care might enhance medical decision-making, improve adherence and outcomes, and potentially reduce overall health care expenditures.
Assuntos
Dermatologia/economia , Custos de Cuidados de Saúde , Dermatopatias/economia , Adulto , Tomada de Decisões , Fármacos Dermatológicos/economia , Feminino , Pesquisas sobre Atenção à Saúde , Humanos , Cobertura do Seguro , Reembolso de Seguro de Saúde , Internato e Residência , Masculino , Pessoa de Meia-Idade , Noroeste dos Estados Unidos , Cooperação do Paciente , Pacientes/psicologia , Relações Médico-Paciente , Médicos/psicologia , Honorários por Prescrição de Medicamentos , Prática Profissional , Dermatopatias/diagnóstico , Dermatopatias/terapia , Revelação da VerdadeRESUMO
We present the case of a male infant with violaceous bullae on the scalp that were initially thought to be bullous aplasia cutis but at 3 months of age were diagnosed as a kaposiform hemangioendothelioma. This diagnosis should be considered when evaluating newborns with bullous plaques on the scalp that do not heal in the first 2-3 weeks of life. Kaposiform hemangioendothelioma (KHE) is a rare vascular tumor that typically presents as a violaceous to purpuric plaque at birth or early infancy. It may be associated with Kasabach-Merritt phenomenon (KMP), a potentially life-threatening consumptive coagulopathy.