Surgical Deroofing for Hidradenitis Suppurativa.

Hidradenitis suppurativa can present in varying degrees of severity; management often poses a challenge for primary care physicians and dermatologists. Deroofing is a surgical technique that has shown superiority over standard excision. We describe the deroofing procedure and review clinical data to provide instruction and support its use.

Metastatic Basal Cell Carcinoma Arising From a Primary Cutaneous Carcinosarcoma.

Primary cutaneous carcinosarcoma is a rare malignant tumor composed of both an epithelial and mesenchymal cell population. We present a case of a man, aged 56 years, found to have a 26-mm exophytic lesion on the vertex scalp identified to contain a distinct population of basal cell carcinoma (BCC) as well as another population of spindled cells representing a poorly differentiated sarcomatous component. Five years after the removal of the primary lesion, the patient presented with metastatic BCC to the right scalp, right cervical nodes, lung, and rib. Next-generation sequencing of the lung metastasis was performed, revealing mutation of the patched gene (PTCH1) and prompting treatment with vismodegib (Erivedge). Cases of primary cutaneous carcinosarcoma with a basal cell epithelial component are rare and not much is known about their pathogenesis or clinical course. This case is unique in that metastatic BCC arose from a primary carcinosarcoma in which the carcinomatous component was basal cell. Furthermore, it has clinical significance in the successful use of a selective hedgehog pathway inhibitor.