Invasive penile squamous cell carcinoma.

Invasive penile squamous cell carcinoma (PSCC) is a rare malignancy with considerable morbidity and mortality. Because a delayed or incorrect diagnosis can have a devastating outcome, physicians should maintain a high index of clinical suspicion for PSCC in patients presenting with penile lesions, particularly in young or middle-aged patients in whom presentation of PSCC is uncommon. We report the case of a 27-year-old circumcised man who presented with invasive PSCC following a diagnosis of condyloma 8 years prior. The patient underwent robotic laparoscopic bilateral pelvis and inguinal lymph node dissection and re-excision of the primary PSCC, with one of 15 superficial right inguinal lymph nodes testing positive for squamous cell carcinoma. Given the patient's single-node positivity as well as the risks associated with chemotherapy with respect to his concurrent medical conditions, close follow-up with repeat imaging was planned following surgery. This case highlights the importance of biopsy in any lesion recalcitrant to conventional treatment modalities regardless of age. Early detection and treatment of PSCC can prevent organ dysfunction, loss of organ, or even death.

The use of Mohs micrographic surgery (MMS) for melanoma in situ (MIS) of the trunk and proximal extremities.

BACKGROUND: Evaluation of the entire surgical margin results in high rates of complete excision, low local recurrence rates, and maximal tissue conservation. Although well recognized for melanoma of the head and neck, few studies have focused exclusively on the trunk and proximal extremities. OBJECTIVE: We sought to evaluate the efficacy of Mohs micrographic surgery for melanoma in situ (MIS) of the trunk and proximal extremities, and determine adequate excision margins for MIS when total margin evaluation is not used. METHODS: Long-term outcomes in 882 cases of MIS treated with Mohs micrographic surgery were analyzed and compared with historical controls. Rates of complete excision were determined for increasing surgical margin intervals. RESULTS: One local recurrence occurred in our cohort (0.1%). Only 83% of MIS were excised with a 6-mm margin. Margins of 9 mm were needed to excise 97% of MIS, statistically equivalent to thin melanomas. LIMITATIONS: We used a nonrandomized, single-institution, retrospective design. CONCLUSION: Mohs micrographic surgery may cure the 17% of MIS that exceed traditional excision margins of 5 mm and is a valuable option for these patients. Surgical margins of at least 0.9 cm should be considered for MIS of the trunk and extremities when total margin evaluation is not used.

The Paramidline Forehead Flap: A Clinical and Microanatomic Study.

BACKGROUND: The traditional paramedian forehead flap (FHF) is an axial flap based on the supratrochlear artery (STA). Doppler examination is often used to ensure inclusion of the STA within the flap. The authors hypothesized that a FHF pedicle design could be simplified to extend from the midline of the glabella to 1.2 cm lateral to the midline without compromising outcomes. OBJECTIVE: To compare clinical outcomes and vessel densities of 2 FHF designs. METHODS: Two FHF designs were used to repair fifty nasal defects. One was based on Doppler identification of the STA; the other on clinical measurements from the glabellar midline (with no effort to identify the STA). Clinical outcomes, complication rates, and pedicle vasculature of both groups were compared. RESULTS: There was no significant difference in flap survival or complication rate. Forehead flaps designed on the paramidline glabella had more arteries within their pedicles than Doppler-based FHFs (p < .05). Small arteries predominated, whereas larger arteries were infrequent in both groups. Size and number of arteries were not related to flap survival. CONCLUSION: A paramidline FHF has equivalent clinical outcomes as a flap based on the STA. A simple and reproducible design of the FHF using only surface landmarks is described.

Nodular amyloidosis: clinical recognition of an unusual entity.

Nodular amyloidosis is a protein deposition disorder that is important to recognize in the clinical setting. Identification and differentiation from primary systemic amyloidosis, which has an identical cutaneous presentation, but serious systemic implications, is of particular significance. Our case report highlights two patients who presented with isolated involvement of the plantar surface and ungual phalanges, each with concomitant tinea pedis. Recognition and diagnosis of cutaneous amyloidosis enables discrimination from systemic disease, and if found, prompt institution of appropriate treatment.

Bullosis diabeticorum associated with a prediabetic state.

Bullosis diabeticorum, or diabetic bullae, is a non-inflammatory blistering condition that is virtually diagnostic of diabetes. Diabetic bullae most often present as painless, tense, superficial bullae that occur in an acral distribution and commonly heal in 2-6 weeks without scarring, but complications such as secondary bacterial infection or hemorrhage may occur. The diagnosis of bullosis diabeticorum in a nondiabetic patient should prompt screening for diabetes. A case of recurrent bullae in a prediabetic patient is presented, with a review of the clinical features and significance of bullosis diabeticorum.

Urticarial vasculitis: a unique presentation.

Urticarial vasculitis is a relatively rare diagnosis in a patient presenting with urticaria. The process is classically described as a generalized eruption, painful more so than pruritic, lasting longer than 24 hours. Two forms of urticarial vasculitis have been described: ahypocomplementemic form more commonly associated with systemic disease, and a normocomplementemic form that is generally limited to the skin. We report on a uniquely distributed vasculitic eruption restricted mainly to the anterior belt line area in a patient presenting with urticaria and intense pruritus. Urticarial vasculitis as a unique entity is reviewed along with its clinical and histopathologic presentation and the pharmacologic agents used for treatment.