Philip R Cohen’s research while affiliated with Touro University and other places

Specialists in forensic medicine assist in crime scene investigations. The forensic medicine experts include anthropologists, ballistic analysts, entomologists, odontologists, and osteologists. The experts are usually not at the crime scene; they provide an evaluation of evidence that is sent to them. After they complete their assessment of the evidence, they prepare a specialized presentation of their findings: a forensic expert analytical report. The format of the report is variable depending on which forensic expert is writing it; however, there are certain mandatory sections that are included: the chain of evidence, the methods of evidence evaluation, the results of the evaluation of the evidence, and the discussion (including the conclusion) of what the evidence demonstrates. Forensic dermatology is an emerging subfield of medicine. Dermatologists are experts in evaluating the skin, mucosa, hair, and nails. It is anticipated that the demand for forensic dermatology will increase as individuals who currently evaluate crime scenes become aware of the potential benefit of consulting a forensic dermatologist. An illustrative hypothetical forensic dermatology expert analytical report is presented. Like other forensic expert analytical reports, the forensic dermatology expert analytical report has four primary sections. The chain of evidence section is a chronologic documentation that not only identifies the protected care and control of the evidence but also the transfer of the evidence to another individual. The methods section is a comprehensive presentation of the analysis of the evidence; it comprises the majority of an analytical report. The results section provides the information obtained after the evidence has been evaluated; it should be written in plain language, so it is readily able to be understood by not only the other investigators but also the members of the legal profession (including the judge and the attorneys) and the members of the jury. The discussion section includes the opinion of the dermatologist and should be a summary of the investigation findings that puts the analysis of the evidence into context; it can include a conclusion section and should also be written in plain language. Depending on the specific circumstances of the case, the template of the illustrative forensic dermatology expert analytical report can be modified by the dermatologists who is preparing their analytical report. In conclusion, an excellent forensic dermatology expert report will aid both other investigators and the members of the legal system—such as the attorneys, judge, and jury—who are involved in the case. In addition, when the forensic dermatology expert testifies as an expert witness in court, the report will be an asset for the dermatologist.

Chromoblastomycosis is an uncommon, chronic granulomatous fungal infection of the skin and subcutaneous tissue. Chromoblastomycosis is most commonly caused by the traumatic inoculation of dematiaceous (pigmented) fungi, most commonly Fonsecaea species, Phialophora species, and Cladophialophora species. Chromoblastomycosis usually affects agricultural workers in tropical and subtropical climates. The World Health Organization classifies chromoblastomycosis as a neglected tropical and occupational disease that commonly affects middle-aged men in poor to middle-income countries. The cutaneous lesions of chromoblastomycosis typically affect the lower extremities and present as polymorphous, hyperkeratotic, or fungating small papules, plaques, verrucous nodules, or ulcers; therefore, a high degree of clinical suspicion is necessary to consider the diagnosis of chromoblastomycosis. The diagnosis is made by visualization of the thick-walled pigmented structures referred to as sclerotic bodies (also known as Medlar bodies or muriform bodies) or pigmented septate hyphae or both on a biopsy specimen of the lesion. Treatment may consist of locally destructive techniques, prolonged systemic antifungal therapy, and/or surgical excision. In this paper, we present an immunocompetent 80-year-old Caucasian woman who developed an isolated lesion of chromoblastomycosis on the forearm while gardening in Texas, a non-endemic area for the disease. Her infection was refractory to systemic antifungal medications and cryotherapy with liquid nitrogen. Ultimately, her fungal infection was successfully treated with a wide local surgical excision of the infectious cutaneous lesion.

Cutaneous basal cell carcinoma (BCC) in situ is a recently recognized subtype of the skin neoplasm in which the abnormal cells are confined to the epidermis. BCC in situ of the skin was previously referred to as a superficial BCC. A review of the world literature has revealed 10 cutaneous BCCs in situ that have been described in nine patients but likely reflect a more general phenomenon. The neoplasm typically presents as an asymptomatic red plaque on the abdomen, upper extremity, back, and chest. Pathologic changes frequently show confluent tumor cells along the epidermal basal layer or superficial aggregates of neoplastic cells that are contiguous with the epidermis and extend into the dermis. Genomic evaluation has been performed in neoplasms from one individual with cutaneous BCC in situ and metastatic BCC; like other variants of BCC, an aberration of the PTCH1 gene was observed. In contrast to his liver metastasis, the in situ carcinoma had a lower tumor mutational burden, lacked programmed death-ligand 1 (PD-L1) and programmed death-ligand 2 (PD-L2) amplification and had a distinct PTCH1 mutation, suggesting that the in situ BCC of his skin and the metastatic BCC of his liver were derived from different clones of cells.

Basal cell carcinoma (BCC) is the most common skin cancer. Skin cancers may present either as a non-invasive tumor or an invasive malignancy. The terminology of carcinoma in situ is used when the tumor is either just limited to epidermis or not present as single cells or nests in the dermis. However, currently the terminology superficial BCC is inappropriately used instead of BCC in situ when the skin cancer is limited to epidermis. In this study we compare the pathologic changes of superficial, nodular, and infiltrative BCCs using electron microscopy to identify the ultrastructural characteristics and validate the previously proposed terminology. Three cases of BCC (superficial BCC, nodular BCC, and infiltrative BCC) diagnosed by dermatopathologists at our institute were selected for review. Paraffin block tissues from these cases were sent for electron microscopy studies which demonstrated disruption of basal lamina in both nodular and infiltrative type of BCC, while it remains intact in BCC superficial type after extensive examination. Therefore, similar to other in situ skin cancers, there is no invasion of the neoplasm in superficial BCC into the dermis. Hence, the older term superficial BCC should be appropriately replaced with the newer terminology BCC in situ.