December 2024
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6 Reads
Annals of Surgical Oncology
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December 2024
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6 Reads
Annals of Surgical Oncology
November 2024
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14 Reads
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1 Citation
Annals of Surgical Oncology
Sentinel lymph node biopsy (SLNB) for head and neck melanomas involves complex challenges due to intricate lymphatic networks and delicate anatomic structures. The Merlin Assay (CP-GEP), merging clinicopathologic data with gene expression profiling, offers a non-invasive method to identify patients who have a low risk for nodal metastasis, potentially sparing these low-risk patients from surgical procedures. This study evaluated 250 clinically node-negative patients with stage I, II, or III melanoma from the Mayo Clinic and University Hospitals Cleveland Medical Center who had tumors in the head and neck region diagnosed between 2004 and 2021. All the patients underwent SLNB. The Merlin Assay, using the CP-GEP model, combines patient age at diagnosis, Breslow thickness, and gene expression of eight specific genes from the primary tumor to predict the risk of nodal metastasis. The SLNB positivity rate was 14% overall, and CP-GEP predicted a possible 40.8% reduction in SLNB procedures with a negative predictive value (NPV) of 98%. For 215 SLNB-negative patients (5-year recurrence-free survival [RFS] of 76.9%, distant metastasis-free survival [DMFS] of 84.3%, and melanoma-specific survival [MSS] of 90.6%), CP-GEP improved risk stratification by identifying 100 patients as low risk with 5-year RFS of 86.1%, DMFS of 92.7%, and MSS of 95.3%. Among 167 T1–T2 patients, the SLNB positivity rate was 8.4%, and CP-GEP achieved an SLNB reduction rate of 56.3% with an NPV of 98.9%. The Merlin Assay effectively categorizes head and neck melanoma patients by risk, enabling more accurate clinical decision-making regarding SLNB and follow-up evaluation, especially for early-stage melanoma patients.
October 2024
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6 Reads
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1 Citation
JAAD Case Reports
September 2024
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4 Reads
Journal of the American Academy of Dermatology
September 2023
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6 Reads
Journal of the American Academy of Dermatology
March 2023
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16 Reads
JAAD Case Reports
January 2023
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146 Reads
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8 Citations
JCI Insight
BACKGROUND Adverse drug reactions are unpredictable immunologic events presenting frequent challenges to clinical management. Systemically administered cholecalciferol (vitamin D3) has immunomodulatory properties. In this randomized, double-blinded, placebo-controlled interventional trial of healthy human adults, we investigated the clinical and molecular immunomodulatory effects of a single high dose of oral vitamin D3 on an experimentally induced chemical rash.METHODS Skin inflammation was induced with topical nitrogen mustard (NM) in 28 participants. Participant-specific inflammatory responses to NM alone were characterized using clinical measures, serum studies, and skin tissue analysis over the next week. All participants underwent repeat NM exposure to the opposite arm and then received placebo or 200,000 IU cholecalciferol intervention. The complete rash reaction was followed by multi-omic analysis, clinical measures, and serum studies over 6 weeks.RESULTSCholecalciferol mitigated acute inflammation in all participants and achieved 6 weeks of durable responses. Integrative analysis of skin and blood identified an unexpected divergence in response severity to NM, corroborated by systemic neutrophilia and significant histopathologic and clinical differences. Multi-omic and pathway analyses revealed a 3-biomarker signature (CCL20, CCL2, CXCL8) unique to exaggerated responders that is suppressed by cholecalciferol and implicates IL-17 signaling involvement.CONCLUSION High-dose systemic cholecalciferol may be an effective treatment for severe reactions to topical chemotherapy. Our findings have broad implications for cholecalciferol as an antiinflammatory intervention against the development of exaggerated immune responses.TRIAL REGISTRATIONclinicaltrials.gov (NCT02968446).FUNDINGNIH and National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS; grants U01AR064144, U01AR071168, P30 AR075049, U54 AR079795, and P30 AR039750 (CWRU)).
December 2022
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52 Reads
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2 Citations
American Journal of Dermatopathology
July 2022
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11 Reads
Dermatologic Surgery
June 2022
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7 Reads
JAAD Case Reports
... Recent studies from various specialties as well as otolaryngology subspecialties have demonstrated declining Medicare physician reimbursement rates. General surgery, 1 neurosurgery, 2 plastic surgery, 3 orthopedic surgery, 4 and dermatology 5,6 have all seen reductions in their respective MPFS procedures as well as downward trends in specific CPTs. No studies to date, however, have evaluated reimbursements for commonly performed procedures within laryngology. ...
December 2022
American Journal of Dermatopathology
... The RNAseq data revealed an array of highly enriched myeloid phagocytes in NM-exposed dermis consistent with the murine models (Figs. 2, 3). In human skin a myriad of myeloid cells including neutrophils, conventional dendritic cells (cDC), plasmacytoid DC (pDC), and monocytes were detected (Fig. 6c) 20 . Contrary to the previously held notion of myeloid-driven skin damage after NM exposure, we also detected a dynamic repository of antigen-experienced memory T lymphocytes, particularly effector memory (Tem) CD4 + helper and CD8 + cytotoxic T cells. ...
January 2023
JCI Insight
... It has been reported to present in a cellulitis-like manner with a similar constellation of symptoms to our patient, including swelling, erythema and tenderness. 10 In these cases, histopathology would demonstrate infiltration of the dermis or subcutaneous tissues with leukaemic cells. Leukaemia cutis is known to be associated with poor prognosis and should be considered in patients with new skin manifestations with a known underlying haematological malignancy. ...
March 2021
Orbit (Amsterdam, Netherlands)
... DM can be challenging to diagnose. Primary tumors can be either amelanotic or melanotic, often resembling other cutaneous malignancies or even benign scar tissue or dermatofibroma [7,8]. Histologically, DM presents as spindle-shaped melanocytes embedded in a dense, fibrous (desmoplastic) collagen matrix, with diminished cellularity relative to other cutaneous melanomas [1]. ...
January 2021
American Journal of Dermatopathology
... As a result, the lipoprotein maturation and trafficking pathways have been a focus of novel antibiotic discovery (6). Several compounds have recently been described that target maturation steps in both E. coli and Acinetobacter baumannii (38)(39)(40)(41). Novel inhibitors of lipoprotein trafficking have also been reported that target LolCDE in E. coli (22)(23)(24). ...
August 2020
International Journal of Dermatology
... Following the first report of the successful treatment of AAV with RTX, different rare clinical manifestations were reported as having been successfully treated with RTX. Some of the most important rare clinical presentations in GPA patients, which resolved following RTX, include retrobulbar granuloma [78], refractory ophthalmic [126], pachymeningitis [146], the presence of orbital inflammation [122], long-established end-stage renal disease [147], post-kidney-transplantation glomerulonephritis-related AAV [148], pituitary GPA [149], renal mass [150], gastric ulcer [151], pancreatitis [152], ophthalmoplegia [153], pyoderma gangrenosum [154][155][156], prostatitis [157] aortic inflammation [158], intestinal involvement [159], mastitis [160], aortitis [161], gingivitis [162], Isolated Pauci-Immune Pulmonary Capillaritis [163], isolated orbital GPA [164], cranial neuropathy [165], severe necrotizing scleritis [166], genital necrosis and inflammation [167], GPA-associated subcutaneous cheek odule [168], pseudo-tumoral digital nodules [169], hypertrophic pachymeningitis [170,171], acute myocarditis [172], palpable purpura [173], central nervous system vasculitis [174], intra-cranial hypertension [175,176], tracheobronchial stenosis [142], acute aortic valve regurgitation [177], GPA-mimicking meningeal tuberculosis [178], gynecological involvement [179], GPA-mimicking lung malignancies [180], CNS ischemic lesions [181], leukocytoclastic vasculitis-induced penile necrosis [182], stem cell transplantation [183], progressive skull base osteomyelitis [184], severe bilateral sensorineural hearing loss [185], nasal septal abscesses [186], oral and skin ulcer [187], nasal septal abscesses [186], membranous nephropathy [188], ventricular tachycardia [189], and hydralazine-induced AAV [190]. ...
May 2020
Journal of Cutaneous Pathology
... SS usually presents in individuals in their sixth decade of life [7,10,11]. Occurrence of SS in the pediatric population is rare (with an estimated 5-8% of cases of SS being reported in children [12]), although several cases of pediatric SS have been recently reported in literature [13][14][15][16][17][18][19][20]. In a 2019 French study of 10 pediatric SS patients, the investigators reported a median age of 2.7 years at presentation and a female to male ratio of 2:3. ...
Reference:
New Practical Aspects of Sweet Syndrome
February 2020
JAAD Case Reports
... Miliaria crystallina (MC) is a superficial form of miliaria when sweat glands are obstructed within the stratum corneum [1]. Although there are few adult cases of MC associated with hypernatremia, there is only one neonatal case of MC associated with hypernatremic dehydration (HD) in the literature [3][4][5]. Herein, we report a second neonatal case with MC developed during treatment of severe HD. ...
September 2019
JAAD Case Reports
... ICI-induced SLR poses a significant diagnostic challenge [6], with the lungs involved in 60% of cases [7,8]. This can mimic metastasis, as the lungs are the most common site of metastasis for RCC [9]. ...
July 2019
International Journal of Clinical Oncology
... It may be associated with bullous and ulcerative lesions on the palms and soles, with or without cicatricial alopecia and oral involvement. There has also been a report of erosive nail LP with underlying radiographic osteomyelitis [66]. ...
March 2019
Cutis