Travis W Vandergriff

• University of Texas Southwestern Medical Center

Background Large and giant congenital melanocytic nevi present a risk for developing melanoma or neurocutaneous melanosis. Most are caused by NRAS or, less commonly, BRAF mutations. Objectives We present a series of patients with large to giant congenital melanocytic nevi with BRAF fusion genes as driver alterations and describe their unique clini...

The clinical penetrance of infectious diseases varies considerably among patients with inborn errors of immunity (IEI), even for identical genetic defects. This variability is influenced by pathogen exposure, healthcare access and host-environment interactions. We describe here a patient in his thirties who presented with epidermodysplasia verrucif...

PCR-based fragment analysis of the T-cell receptor (TCR) gene is used extensively in diagnostic labs to assess clonality in T-cell populations in multiple tissue sites. Of the numerous TCR assays that have been reported, studies assessing use on biopsies suspicious for mycosis fungoides specifically are lacking. We compared clonality findings from...

Several vulvar lichen sclerosus (VLS) clinical severity scales have recently been proposed. In this prospective case series, we characterized histopathology in the context of clinical severity in 6 treatment-naïve postmenopausal patients with VLS. The Vulvar Quality of Life Index (VQLI) and an adaptation of the 2018 International Society for the St...

Cutaneous mucormycosis is a rapidly advancing fungal infection that most commonly occurs due to airborne spread or direct inoculation and requires early detection and prompt treatment for optimal survival. Major risk factors include diabetes, transplantations, malignancies, surgical procedures, and HIV. Diagnostic criteria are based on microscopy a...

BACKGROUND: Alterations in the tumor microenvironment (TME) can result in a “T-cell inflamed” TME, which is characterized by activation of the PD1/PD-L1 pathway, immunosuppression, and production of anergic, “exhausted” CD8(+)-T-cells. Similar alterations in the TME of Mycosis Fungoides (MF) have been linked to disease progression. However, the rel...

This chapter focuses on leprosy, an ancient disease that has been the cause of great morbidity and mortality for centuries. A 4,000-year-old skeleton with evidence of lepromatous leprosy was found in India, and DNA from the causative agent, Mycobacterium leprae , has been isolated from a Byzantine skeleton from Israel dated to 300–600 ad . More rec...

Podophyllotoxin (PPT) is used to treat condylomata acuminata and works by destabilizing microtubules within epithelial cells, leading to mitotic arrest in metaphase. PPT-induced changes to the epidermis can cause histological findings mimicking dysplasia. Here, we present a case of vulvar condyloma acuminatum treated with PPT, showing ballooning de...

We present a severe case of acute generalized exanthematous pustulosis (AGEP) secondary to trimethoprim‐sulfamethoxazole complicated by non‐infectious circulatory shock in a 16‐year‐old boy. Hemodynamic instability has been reported as a complication of AGEP in adults, but is rarely observed in pediatric patients. The patient we present demonstrate...

Sarcoidosis is a disease that can affect a multitude of organs and manifest as cutaneous disease. Cutaneous manifestations of sarcoidosis vary widely in morphology, earning the nickname of "great imitator," and the diagnosis often requires clinicopathologic correlation and additional laboratory and radiographic workup. We present the case of a 42-y...

Basal cell carcinoma (BCC) is characterized by slow but locally invasive growth. Although there is low metastatic potential, if not treated early, these skin cancers can lead to significant morbidity and mortality. In this case report, we present a man with a neglected BCC that developed into what is termed a giant BCC or one that is greater than 5...

Background Cutaneous histopathologic diagnoses in children often differ from those in adults. Depending on practice setting, these specimens may be evaluated by dermatopathologists or pediatric pathologists. We sought to determine whether comfort level with pediatric dermatopathology is associated with prior training, pediatric dermatopathology exp...

Blastic plasmacytoid dendritic cell neoplasm is a rare hematologic neoplasm originating from plasmacytoid dendritic cell precursors that has an aggressive disease course with typically poor prognosis. Herein, we report a man in his early twenties who presented with rapid onset of violaceous nodules and purpuric papules and macules that began on his...

Background: Maintenance of Certification (MOC) is a recertification program required by the American Board of Dermatology (ABD). The program was created because continuing medical education (CME) was viewed as inadequate in keeping physicians’ knowledge up to date. In July 2016, UTSW incorporated MOC content into Grand Rounds.Objective: To identify...

Chondrodermatitis nodularis helicis is a relatively common ulcerative, inflammatory condition affecting the skin and cartilage of the ear. We present a case of chondrodermatitis affecting the skin and cartilage of the nose, designated chondrodermatitis nodularis nasi . Clinically, chondrodermatitis presents as a singular, painful, ulcerated papule...

Metastasis requires cancer cells to undergo metabolic changes that are poorly understood1–3. Here we show that metabolic differences among melanoma cells confer differences in metastatic potential as a result of differences in the function of the MCT1 transporter. In vivo isotope tracing analysis in patient-derived xenografts revealed differences i...

A 28-year-old man with a history of mycosis fungoides presented for evaluation of multiple dark-brown macules and hyperpigmented dome-shaped papules on the distal tongue. A shave biopsy of the tongue revealed melanin pigment in the basal keratinocytes and melanophages in the lamina propria, consistent with pigmented fungiform papillae of the tongue...

A 19‐year‐old Caucasian female with adult onset Still’s disease (AOSD) presented for evaluation of an acute clinical decompensation and atypical annular papules and plaques with purpura on the lower extremities. A punch biopsy demonstrated histiocytes with engulfed degenerated erythrocytes and lymphocytes, consistent with hemophagocytic lymphohisti...

Proliferating cells, compared with quiescent cells, are more dependent on glucose for their growth. Although glucose transport in keratinocytes is mediated largely by the Glut1 facilitative transporter, we found that keratinocyte-specific ablation of Glut1 did not compromise mouse skin development and homeostasis. Ex vivo metabolic profiling reveal...

Erythema elevatum diutinum (EED) is a rare, cutaneous vasculitis of uncertain origins. EED can present clinically as chronic bilateral, symmetrical, periarticular papules, plaques, and nodules. We report here an unusual case of EED presenting as multiple, densely fibrosing nodules on the feet of a 60 year-old HIV positive woman. The initial evaluat...

A 22-year-old woman with a history of systemic lupus erythematosus was readmitted with fever and a generalized eruption. Six days prior to this admission, she had been hospitalized for a photo-induced flare of acute cutaneous lupus erythematosus (ACLE). At readmission, she was febrile with a temperature of 101.5°F, and on examination, she had a wor...

Distinguishing primary cutaneous adnexal carcinoma from metastatic carcinoma of unknown primary can be a diagnostic challenge due to the frequent overlap of histologic and immunohistochemical features. A 58-year-old man presented with a tender, indurated plaque on axillary skin. Biopsy revealed infiltrating atypical cells throughout the dermis, wit...

Background: Human polyomavirus (HPyV)6 and HPyV7 are shed chronically from human skin. HPyV7, but not HPyV6, has been linked to a pruritic skin eruption of immunosuppression. Objective: We determined whether biopsy specimens showing a characteristic pattern of dyskeratosis and parakeratosis might be associated with polyomavirus infection. Metho...

We present the case of a 28-year-old male with a history of HIV with a 1-month history of a steadily enlarging, firm painful lesion on the right posterior shoulder. The patient was initially treated for cellulitis given his clinical picture. Histopathologic examination revealed an angiocentric and dermal proliferation of markedly atypical lymphoid...

Background: Angiosarcoma is a malignancy of vascular endothelial cells which may arise secondarily as a complication of lymphedema, including chronic lymphedema of morbid obesity. Amplifications in MYC are frequently present in secondary angiosarcoma (arising in irradiated sites and chronic lymphedema) and less frequently in primary cutaneous angi...

Nature Communications 7 Article number:12336 (2016); Published 22 August 2016; Updated 29 September 2016 Arthur E. Frankel, who helped to interpret the clinical relevance of the findings, was inadvertently omitted from the authors list during the final stages of production. This has now been corrected in both the PDF and HTML versions of the Articl...

We report the case of a patient with a long-standing history of extranodal, sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman disease) and no evidence of original cutaneous involvement as well as a history of herpes zoster of the left flank with post-herpetic neuralgia who went on to develop multiple, round-to-oval, red-brown, atrophi...

New therapies are required for melanoma. Here, we report that multiple cardiac glycosides, including digitoxin and digoxin, are significantly more toxic to human melanoma cells than normal human cells. This reflects on-target inhibition of the ATP1A1 Na + /K + pump, which is highly expressed by melanoma. MEK inhibitor and/or BRAF inhibitor additive...

Supplementary Figures 1-8

It is known that eosinophilic fasciitis can be associated with monoclonal gammopathy. There is clinical similarity between eosinophilic fasciitis and morphea profunda, but it is unclear whether morphea profunda might be associated with monoclonal gammopathy. The temporal quantification of gammopathy in morphea profunda has not been well characteriz...

Many diseases of the gastrointestinal tract have characteristic dermatological manifestations. Such manifestations may develop before, concomitantly with, or after the onset of gastrointestinal diseases. Recognition of the cutaneous manifestations of gastrointestinal diseases may be of significance for purposes of diagnosis and management. This cha...

Background: Recently, isolated reports of pyoderma gangrenosum (PG) secondary to levamisole-contaminated cocaine have been described, with similar serologic findings to the vasculopathic presentation. Objective: We sought to describe clinical, histopathological, and serologic findings in 8 patients with PG associated with levamisole-contaminated...

Fixed drug eruptions (FDE) comprise 10 percent of all adverse cutaneous drug reactions and generalized bullous fixed drug eruptions (GBFDE) are a rare subset of FDEs. We present a patient with severe GBFDE caused by ibuprofen successfully treated with cyclosporine. Further work is needed to determine if cyclosporine can be an effective therapy for...

Confetti-like depigmentation was noted in patients reporting recent worsening of vitiligo. We sought to determine if confetti-like depigmentation is a marker of rapidly progressing vitiligo. Review of patient records and images of patients from a vitiligo registry resulted in 7 patients with 12 images that fit inclusion criteria and were evaluated...

Epidemiology Leprosy is an ancient disease that has been the cause of great morbidity and mortality for centuries. A 4000-year-old skeleton with evidence of lepromatous leprosy was found in India, and DNA from the causative agent, Mycobacterium leprae, has been isolated from a Byzantine skeleton from Israel dated to 300–600 AD. Mycobacterium leprae...

Plaque-like cutaneous mucinosis (PCM) is a rare disorder of dermal mucin deposition. Some patients with PCM will be found to have an associated malignancy. We report the case of a 72-year-old man presenting with new onset pruritic, waxy-appearing erythematous and skin-colored papules and nodules coalescing into plaques on his shoulder, scalp, and f...

Mycosis fungoides (MF) is the most common subtype of cutaneous T-cell lymphoma and is often difficult to diagnose. Early stage disease is particularly challenging and requires clinical and histopathologic correlation to make an accurate diagnosis. In order to facilitate the diagnosis of early MF, an algorithm has been proposed by the International...

Deficiency in the E3 ubiquitin ligase Itch causes a skin-scratching phenotype in mice. We found that there was increased phosphorylation and activation of the mitogen-activated protein kinase p38α in spontaneous and experimentally induced skin lesions of Itch-deficient (Itch(-/-)) mice. Itch bound directly to the TGF-β-activated kinase 1-binding pr...

Drug-induced delayed multi-organ hypersensitivity syndrome (DIDMOHS), also known as drug reaction (or rash) with eosinophilia and systemic symptoms (DRESS), drug-induced hypersensitivity syndrome (DIHS), or drug hypersensitivity syndrome (DHS) is a rare, potentially fatal, drug-induced hypersensitivity reaction characterized by cutaneous eruption,...

Erythema multiforme in its most extreme form has traditionally been divided between toxic epidermal necrolysis and Stevens-Johnson Syndrome. These two life-threatening skin diseases are now considered part of the same spectrum of disease. They can be differentiated by clinical and histological criteria. We can also now predict which patients are ap...

Scabies limited to the nail unit is quite unusual, but may persist after treatment of crusted scabies. We present a man with a history of crusted scabies that resolved with treatment, but later the patient reported a chronic problem with crumbly, thickened nails, which were found to be harboring scabies mites.

Primary immunodeficiencies (PIDs) are conditions caused by molecular defects in the genes required for normal immune function. PIDs are rare, with a prevalence of approximately 1 in 25,000. Though much remains to be explored in the field of PIDs, over 185 distinct defects have been described. Infections are generally the most pronounced feature of...

There are no validated outcome measures for postinflammatory hyperpigmentation (PIH). We sought to determine the reliability and validity of an outcome measure for PIH after acne in patients with skin of color. A postacne hyperpigmentation index (PAHPI) was developed. Six raters scored 21 patients with PIH twice. Reliability was determined within a...

Importance Wounds that heal under tension lead to wider and more conspicuous scars and result in decreased long-term patient satisfaction. We hypothesized that prolonged intradermal suture lifetime can decrease scar spread in wounds under tension. Objective To determine whether prolonged intradermal support would help decrease scar spread. Design P...

Core Messages: Squamous cell carcinoma (SCC) of the skin is an invasive, malignant neoplasm arising from the keratinizing cells of the suprabasilar epidermis or epidermal appendages. SCC and basal cell carcinoma (BCC) comprise the majority of nonmelanoma skin cancers (NMSCs), and together they account for the most common malignancy worldwide. SCC r...