-
[show abstract]
[hide abstract]
ABSTRACT: Cutaneous metastases are common sequelae of primary malignant melanoma. Because patients with melanoma are examined frequently after diagnosis, it is important that dermatologists are aware of the range of findings that may represent metastatic disease. Many case reports and a few retrospective series have been published detailing the wide variety of clinical presentations of cutaneous metastatic melanoma. This article reviews the various manifestations of metastatic melanoma of the skin and oral mucous membranes and summarizes treatment options for metastatic disease.
International journal of dermatology 03/2012; 51(3):243-9. · 1.18 Impact Factor
-
International journal of dermatology 01/2012; · 1.18 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Erythromelalgia has not been well characterized in the pediatric population.
We sought to review our experience of erythromelalgia in the pediatric age group.
We conducted a retrospective review of patients 18 years of age and younger with a diagnosis of erythromelalgia who were examined at Mayo Clinic in Rochester, MN, from 1970 to 2007.
The records of 32 patients (girls, 22 [69%]) were evaluated. Mean age was 14.1 years (range, 5-18 years) and mean time to diagnosis was 5.2 years. Seven patients (22%) had a first-degree relative with erythromelalgia; 4 were from the same family. Physical activity was limited because of discomfort in 21 patients (66%) and school attendance was affected in 11 patients (34%). Noninvasive vascular studies, which compared temperature, laser Doppler flow, and transcutaneous oximetry in the toes, identified vascular abnormalities in 13 (93%) of 14 patients. Neurophysiologic studies with autonomic reflex screening (including quantitative sudomotor axon reflex test and thermoregulatory sweat testing) showed evidence of a small-fiber neuropathy involving the skin in 10 (59%) of 17 patients studied; there was no evidence of large-fiber neuropathy in 20 patients in whom electromyographic and nerve conduction studies were performed. Topical lidocaine was the most commonly prescribed treatment (44%). Fifteen patients were monitored for an average of 9.1 years (median, 5.0 years; range, 0.4-23.7 years). At last follow-up, 5 patients had stable disease, 4 showed improvement, two had resolution, one reported worsening of symptoms, and 3 had died (one suicide).
Conclusions are limited because this was a retrospective chart review.
Erythromelalgia in pediatric patients is associated with substantial morbidity and even death. The majority of cases are not inherited. Most patients studied have associated small-fiber neuropathy. The disease course is variable. A reliable and safe treatment has not been determined.
Journal of the American Academy of Dermatology 07/2011; 66(3):416-23. · 3.99 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Most anticoagulants are not associated with increased risk of severe complications during cutaneous surgery, but no data exist on clopidogrel.
We sought to determine frequency and severity of perioperative complications in patients taking clopidogrel-containing anticoagulation.
This was a retrospective review of medical records of patients undergoing Mohs micrographic surgery at Mayo Clinic, Rochester, MN, while taking clopidogrel-containing anticoagulation between 2004 and 2008, compared with control subjects taking aspirin monotherapy or no anticoagulants.
In all, 220 patients taking clopidogrel-containing anticoagulation underwent 363 surgical procedures on 268 occasions. Severe complications occurred in 11 of 363 surgical sites in 10 cases. Clopidogrel-containing anticoagulation was 28 times more likely than no anticoagulation and 6 times more likely than aspirin monotherapy to result in severe complications after Mohs procedures (P < .001 and P = .022, respectively). Severe complications were 8 times more likely after Mohs procedures in patients taking both clopidogrel and aspirin than in control subjects taking aspirin monotherapy (P = .009). No statistically significant difference was found between patients taking clopidogrel monotherapy and control subjects not taking anticoagulants (P = .15). Patients experiencing severe complications were more likely to have larger postoperative surgical sites (P < .001). No thrombotic complications were encountered with discontinuation of clopidogrel-containing anticoagulation; a postoperative thrombotic complication occurred in one patient whose clopidogrel-containing anticoagulation regimen was modified.
Retrospective nature of study, possible recall bias as a result of telephone contact, and small number of severe complications were limitations, which reduced study power.
Cutaneous surgery in patients taking clopidogrel-containing anticoagulation is associated with an increased risk of nonlife-threatening severe complications.
Journal of the American Academy of Dermatology 04/2011; 65(3):584-91. · 3.99 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Exotic woods from tropical and subtropical regions (eg, from South America, south Asia, and Africa) frequently are used occupationally and recreationally by woodworkers and hobbyists. These exotic woods more commonly provoke irritant contact dermatitis reactions, but they also can provoke allergic contact dermatitis reactions. We report three patients seen at Mayo Clinic (Rochester, MN) with allergic contact dermatitis reactions to exotic woods. Patch testing was performed and included patient-provided wood samples. Avoidance of identified allergens was recommended. For all patients, the dermatitis cleared or improved after avoidance of the identified allergens. Clinicians must be aware of the potential for allergic contact dermatitis reactions to compounds in exotic woods. Patch testing should be performed with suspected woods for diagnostic confirmation and allowance of subsequent avoidance of the allergens.
Dermatitis 04/2011; 22(2):E1-6. · 1.21 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Accurate surgical current procedural terminology (CPT) coding allows for proper reimbursement, decreases the possibility of being audited, and decreases the likelihood of inadvertently misrepresenting a claim. The CPT codes describe the type of services provided to a patient. CPT modifiers provide information to insurance payers to assure that the provider is reimbursed correctly. When coding for reconstruction of a surgical defect, the appropriate code is determined by the type of reconstruction performed. Reconstructive procedures that are performed because of underlying tumors are reimbursed. Adequate documentation is essential, because this substantiates claims and promotes their timely processing.
Dermatologic clinics 04/2011; 29(2):341-55, xi. · 1.29 Impact Factor
-
Clinical Toxicology 11/2010; 48(9):958. · 2.22 Impact Factor
-
Journal of the American Academy of Dermatology 08/2010; 63(2):343-4. · 3.99 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To clarify clinicopathologic features and reconcile discrepancies in previous studies of folliculotropic mycosis fungoides (FMF).
A single-center retrospective clinicopathologic study and a systematic review of FMF.
Tertiary referral center in the midwestern United States.
Patients with clinical and histopathologic evidence of FMF seen at the tertiary referral center during a 12(1/2)-year period.
Clinicopathologic features of FMF.
Fifty patients (32 male [64%] and 18 female [36%]) met study criteria for the clinicopathologic review. Pruritic patches, plaques, and folliculocentric lesions (milia, cysts, and alopecia) on the head, neck, and trunk were common clinical findings. The mean time to diagnosis of FMF was 5.0 years. Diagnostic latency did not affect risk of death. One-year and 5-year overall survival rates were 96% and 62%, respectively. Frequent microscopic features were follicular mucinosis (74%) and epidermotropism (54%). Systematic review of 186 additional patients confirmed male predominance (ratio of men to women, 3.2:1.0), prevalent pruritus (73%), frequent follicular mucinosis (69%) and epidermotropism (37%) microscopically, and common head, neck, and trunk involvement. Combined data demonstrated that 6% of patients with FMF had concurrent non-mycosis fungoides hematologic malignant neoplasms and that the 5-year overall survival rate was 62% to 64%.
Folliculotropic mycosis fungoides has distinct clinical and microscopic features and is associated with a poor 5-year overall survival rate.
Archives of dermatology 06/2010; 146(6):607-13. · 4.76 Impact Factor
-
International journal of dermatology 05/2009; 48(4):439-40. · 1.18 Impact Factor
-
American Journal of Hematology 04/2009; 85(1):75-6. · 4.67 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: We undertook a clinical and histopathological analysis of patients presenting with Meyerson's naevi. Eleven patients with the characteristic histological features of a Meyerson's naevus were identified over a 5-year period. Diagnostic criteria included epidermal spongiosis and a dermal inflammatory infiltrate associated with a banal junctional or compound naevus. Cases were excluded if naevus cells showed moderate to severe atypia or regression. Patients were contacted by phone and interviewed regarding their lesions. The most common clinical appearance was a solitary, pruritic, erythematous eruption encircling a pre-existing pigmented naevus. The trunk and proximal upper extremities were preferentially affected. Only one clinician listed Meyerson's naevus in the clinical differential diagnosis. All cases demonstrated a pigmented junctional or compound naevus with epidermal spongiosis, parakeratosis and a perivascular lymphohistiocytic inflammatory infiltrate with scattered eosinophils. The inflammatory infiltrate consisted almost exclusively of CD3+ lymphocytes, the majority of which were CD4+. However, a substantial number were CD8+. In all patients, the lesions cleared with excision or spontaneously, without recurrence or progression to melanoma. The aetiology of this entity remains unclear and most clinicians are unlikely to be familiar with it.
Australasian Journal of Dermatology 12/2008; 49(4):191-5. · 1.00 Impact Factor
-
Archives of dermatology 09/2008; 144(8):1066; author reply 1066-7. · 4.76 Impact Factor
-
American Journal of Hematology 03/2008; 84(1):60-1. · 4.67 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: In the last several years, amantadine has been increasingly prescribed for akinesia in Parkinson's disease and to combat fatigue associated with multiple sclerosis. Amantadine is a well-known medication involved in drug-induced livedo reticularis (LR), yet remains under-reported in the English literature. We describe 2 patients with amantadine livedo reticularis: one patient with multiple sclerosis had, previous to this eruption, tolerated 4 years of amantadine therapy without adverse reactions and another patient with Parkinson's disease who developed LR 1 month after starting amantadine.
Journal of drugs in dermatology: JDD 04/2006; 5(3):288-9. · 1.57 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Superficial granulomatous pyoderma is a rare entity thought to be a variant of pyoderma gangrenosum and is often mistaken for classic pyoderma gangrenosum. Superficial granulomatous pyoderma has mainly been described in adults. We describe a case of Superficial granulomatous pyoderma in an 11-year-old girl and present a review of the literature. Superficial granulomatous pyoderma maintains clinical and histopathologic characteristics distinct from classic pyoderma gangrenosum and has a more favorable prognosis. It is often responsive to conservative treatment.
Pediatric Dermatology 27(5):496-9. · 1.07 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Patients with autoimmune and inflammatory conditions often receive long-term immunosuppressive therapy. Some of the largest patient populations with iatrogenic immunosuppression include patients who have received solid-organ transplants or who have rheumatoid arthritis or psoriasis. Although treatments improve patient outcomes, individuals with immunosuppression subsequently may have an increased risk of skin cancer, including squamous cell carcinoma, basal cell carcinoma, and malignant melanoma.
Clinics in dermatology 29(6):602-13. · 3.11 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: A 60-year-old white man seen in consultation for "chronic zoster" presented with a 30-year history of persistent, painful cutaneous lesions on his right flank. His pain was episodic and exacerbated by physical touch and emotional stress. He denied lesion sensitivity to cold or heat. Application ofcapsaicin cream had been without benefit. There was no family history of similar lesions. Physical examination revealed multiple, pink to violaceous, firm, tender nodules (3-7 mm) arising on the right flank in a segmental distribution (Figure 1). No other lesions were noted. A biopsy specimen showed findings of dermal proliferation of spindle-shaped cells with eosinophilic cytoplasm and blunt-ended nuclei without cytologic atypia (Figure 2A and Figure 2B). All of these findings were compatible with a diagnosis of segmental cutaneous piloleiomyomata. He declined surgical or medical intervention.
SKINmed 8(4):238-9.
