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Skin necrosis following digital wart intralesional injection of cantharidin. 数字疣局部注射卡他林后皮肤坏死。
Q3 Medicine Pub Date : 2024-10-15 DOI: 10.5070/D330564434
Sebastian D Arango, Tristan B Weir, Andrew J Miller, Meredith N Osterman

A right-hand-dominant female presented 5 weeks following a right middle finger intralesional cantharidin injection for a common wart by a dermatologist. The patient experienced progressive stiffness, blistering, swelling, pain, and ultimately, full-thickness skin necrosis surrounding the injection site. Careful debridement followed by a full-thickness skin graft was performed with no evidence of involvement of the germinal matrix or terminal extensor tendon. At the 7-month postoperative mark, the patient's graft exhibited favorable healing and improved functionality that did not require further follow-up. Intralesional injection of cantharidin solutions for digital warts leads to progressive skin necrosis. Our case required prompt debridement and defect coverage. Involvement of the underlying anatomical structures was also a concern. Dermatologists and hand surgeons should be familiar with this complication as intralesional cantharidin injections are contraindicated.

一位右手占优势的女性在皮肤科医生为常见疣进行右手中指局部斑蝥素注射后5周。患者经历进行性僵硬、起泡、肿胀、疼痛,最终在注射部位周围出现全层皮肤坏死。仔细清创后进行全层皮肤移植,没有证据表明生发基质或末梢伸肌腱受累。术后7个月,患者的移植物表现出良好的愈合和功能改善,无需进一步随访。斑内注射斑蝥素溶液治疗指疣导致进行性皮肤坏死。我们的病例需要及时清创和修复缺陷。潜在解剖结构的受累也是一个问题。皮肤科医生和手外科医生应该熟悉这种并发症,因为局部注射斑蝥素是禁忌。
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引用次数: 0
The use of dupilumab for the treatment of alopecia areata. 使用杜必鲁单抗治疗斑秃。
Q3 Medicine Pub Date : 2024-10-15 DOI: 10.5070/D330564438
Iman Ali, Emelie E Nelson, Brandy Phan, Veda Kulkarni, Christina McGee, Emily Cao, Rashid M Rashid
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引用次数: 0
Botryomycosis associated with retained hair piece and accompanying ethnic hair considerations. 与残留发片有关的肉孢子菌病以及随之而来的种族头发问题。
Q3 Medicine Pub Date : 2024-10-15 DOI: 10.5070/D330564440
Anna Conner, Amy Musiek, Ethan Barnes, Nupur Singh, Zachary Nahmias
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引用次数: 0
Rural access to dermatology services: a call to action. 农村获得皮肤科服务:行动呼吁。
Q3 Medicine Pub Date : 2024-10-15 DOI: 10.5070/D330564425
Bethany Brumbaugh, Jag Lally, Robert Brodell

This commentary underscores the urgent issue of limited access to dermatologic care in rural areas, leading to adverse health outcomes. With only 10% of dermatologists practicing in rural America, the "rural mortality penalty" contributes to escalating morbidity and mortality. Disparities in dermatologist distribution, particularly in minority-majority counties with lower incomes, worsen health inequities. Despite these challenges, initiatives such as pipeline programs, rural university offices, rural dermatology residency tracks, teledermatology, and Project ECHO (a collaborative model of medical education and care) are promising. This commentary stresses the need for academic dermatologists to recruit more rural medical students and train more residents with a rural upbringing. This predicts future practice in such communities. Immediate action to address the widening rural dermatology gap is needed. The formation of the Rural Access to Dermatology Society, with its first meeting in the spring of 2024 at the annual meeting of the American Academy of Dermatology, is a key part of this process.

本评论强调了农村地区获得皮肤科护理的机会有限这一紧迫问题,这导致了不良的健康结果。只有10%的皮肤科医生在美国农村执业,“农村死亡率惩罚”导致发病率和死亡率不断上升。皮肤科医生分布的差异,特别是在收入较低的少数民族占多数的县,加剧了卫生不平等。尽管存在这些挑战,但诸如管道项目、农村大学办公室、农村皮肤科住院医师培训、远程皮肤科和Project ECHO(医学教育和护理的合作模式)等倡议仍很有希望。这篇评论强调学术皮肤科医生需要招收更多的农村医学生,并培养更多有农村教育背景的住院医生。这预示着这类社区未来的做法。需要立即采取行动,解决日益扩大的农村皮肤科差距。农村皮肤病学协会的成立是这一进程的关键部分,其首次会议将于2024年春季在美国皮肤病学会年会上举行。
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引用次数: 0
Exploring opposing arguments in the call for randomized controlled trials to demonstrate benefit of Mohs micrographic surgery for cutaneous melanoma. 在呼吁进行随机对照试验以证明莫氏显微放射手术治疗皮肤黑色素瘤的益处时,探讨了对立的论点。
Q3 Medicine Pub Date : 2024-10-15 DOI: 10.5070/D330564424
Nahid Y Vidal, Keegan O'Hern, Aaron Steen, Sama Carley, Ji Won Ahn

Importance: The call for robust randomized clinical trials (RCTs) comparing Mohs micrographic surgery (MMS) with wide local excision for treatment of melanoma has stymied the development of guidelines for MMS despite growing evidence of benefit. This commentary explores the controversy by detailing opposing arguments, reviewing the relevant evidence supporting the use of MMS for early-stage melanoma, and discussing the role that RCTs may play in development of national guidelines for surgical treatment options for melanoma. Randomized clinical trials are considered the gold standard of clinical research, but there are no such trials currently to support MMS for melanoma. However, there is a growing literature base of retrospective and prospective cohorts and meta-analyses consistently demonstrating the efficacy and cost-effectiveness of MMS for melanoma. The dearth of clear consensus guidelines has contributed to confusion by referring specialties, controversy across specialties managing melanoma, and inequality in access. Recognizing that this is an ongoing area of discussion within dermatologic surgery, we explore opposing arguments with regard to the demand for RCT data to support dermatologic surgery practices.

重要性:尽管有越来越多的证据表明,Mohs显微手术(MMS)与广泛局部切除治疗黑色素瘤的疗效比较,但要求进行强有力的随机临床试验(rct)的呼声阻碍了MMS指南的制定。本文通过详细阐述反对意见,回顾支持MMS治疗早期黑色素瘤的相关证据,并讨论随机对照试验在制定黑色素瘤手术治疗方案的国家指南中可能发挥的作用,探讨了这一争议。随机临床试验被认为是临床研究的黄金标准,但目前还没有这样的试验来支持MMS治疗黑色素瘤。然而,越来越多的回顾性和前瞻性队列和荟萃分析的文献基础一致证明了MMS治疗黑色素瘤的疗效和成本效益。缺乏明确的共识指南导致了转诊专业的混乱,黑素瘤管理专业之间的争议,以及获取的不平等。认识到这是皮肤外科中一个正在进行的讨论领域,我们探讨了关于需要RCT数据来支持皮肤外科实践的对立观点。
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引用次数: 0
Fungating mass on the breast of a male patient. 一名男性患者乳房上的瘘管肿块。
Q3 Medicine Pub Date : 2024-10-15 DOI: 10.5070/D330564436
Jeremy K Bray, Christina Dai, Olayemi Sokumbi

Breast cancer is one of the most common malignancies that can lead to cutaneous metastasis. Dermatopathologists often play an important role in the diagnosis of breast cancer metastasis to the skin. Rarely, dermatopathologists render a histopathologic diagnosis of primary breast cancer. We discuss a 51-year-old man with metastatic breast adenocarcinoma who presented after admission to the intensive care unit in the setting of altered mental status and critical anemia. Examination revealed a 14cmx12cm ulcerated, fungating tumor occupying the left breast. A four mm punch biopsy from the mass showed cords of atypical cells infiltrating the mid-to-deep dermis positive for CK7, GATA3, ER and PR. CK20, P40, p63, and TTF1 stains were negative. HER2/NEU immunoperoxidase stain was negative. CA15-3 was elevated at 75U/ml. Taken together, he was diagnosed with primary left breast ductal adenocarcinoma, grade two with subsequent visceral metastases to the bones, lymph nodes, and lungs. Although male breast cancer makes up less than 1% of all breast cancers, its incidence has been increasing worldwide. Recognition of the unique clinical and histologic findings of primary breast carcinoma is important to avoid delay in the diagnosis and initiation of appropriate treatment.

乳腺癌是最常见的恶性肿瘤之一,可导致皮肤转移。皮肤病理学家通常在乳腺癌皮肤转移的诊断中发挥重要作用。很少有皮肤病理学家对原发性乳腺癌进行组织病理学诊断。我们讨论了一位51岁的男性转移性乳腺腺癌患者,他在进入重症监护室后出现精神状态改变和危重性贫血。检查发现左侧乳房有一个14cmx12cm的溃疡性真菌瘤。肿块4毫米穿刺活检显示非典型细胞浸润真皮中至深部,CK7、GATA3、ER和PR呈阳性。CK20、P40、p63和TTF1染色呈阴性。HER2/NEU免疫过氧化物酶染色阴性。CA15-3升高至75U/ml。综上所述,他被诊断为原发性左乳导管腺癌,二级,随后内脏转移到骨骼、淋巴结和肺部。尽管男性乳腺癌在所有乳腺癌中所占比例不到1%,但其发病率在世界范围内一直在增加。认识到原发性乳腺癌独特的临床和组织学表现是重要的,以避免延误诊断和开始适当的治疗。
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引用次数: 0
A cross-sectional analysis of insurance acceptance among Mohs micrographic surgeons in New York City. 对纽约市莫氏显微手术外科医生接受保险情况的横断面分析。
Q3 Medicine Pub Date : 2024-10-15 DOI: 10.5070/D330564439
Katie Roster, Sumaiya Islam, Farhha Feroz, Shelcie Fabre, Zahidul Islam, Abigail Cline, Shari R Lipner
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引用次数: 0
Comments on a recent paper Jellyfish envenomation with delayed hypersensitivity and concurrent SARS-CoV-2 infection. 对最近发表的一篇论文的评论 水母螫伤伴有迟发性超敏反应和并发 SARS-CoV-2 感染。
Q3 Medicine Pub Date : 2024-10-15 DOI: 10.5070/D330564443
Gerald L Crow, Brenden S Holland
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引用次数: 0
Personalized melanoma grading system: a presentation of a patient with four melanomas detected over two decades with evolving whole-body imaging and artificial intelligence systems. 个性化黑色素瘤分级系统:一名患者的四个黑色素瘤检测超过二十年,不断发展的全身成像和人工智能系统。
Q3 Medicine Pub Date : 2024-10-15 DOI: 10.5070/D330564426
Rhett Drugge, Xhuljeta Naqo, Sabina Dedej, Galyna Girnyk, Jona Naqo, Frank Drugge, Elgida Volpicelli

Melanoma is a life-threatening tumor that significantly impacts individuals' health and society worldwide. Therefore, its diagnostic tools must be revolutionized, representing the most remarkable human efforts toward successful management. This retrospective study includes the multidimensional analysis of five melanomas in a man in our clinic including whole-body photography, dermatoscopy, artificial intelligence system, genetic test, and the final histopathological conclusion. The correlation between findings in each diagnostic step is discussed. The value of the melanoma grading system will be the application in high-risk lesions to make the right management decision.

黑色素瘤是一种危及生命的肿瘤,严重影响着全世界的个人健康和社会。因此,它的诊断工具必须革命,代表最显著的人类努力向成功的管理。本回顾性研究包括对我们诊所的5例男性黑色素瘤的多维分析,包括全身摄影、皮肤镜检查、人工智能系统、基因检测和最终的组织病理学结论。讨论了每个诊断步骤的结果之间的相关性。黑素瘤分级系统的价值将是应用于高危病变做出正确的管理决策。
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引用次数: 0
Bevacizumab-induced subungual hemorrhage. 贝伐珠单抗引发的真皮下出血。
Q3 Medicine Pub Date : 2024-10-15 DOI: 10.5070/D330564427
Jacob J Owen, Sloan Long, Kimberly Mullinax, John Griffin

Exudative (wet) age-related macular degeneration can be treated with the vascular endothelial growth factor (VEGF)-inhibiting monoclonal antibody bevacizumab. Currently, bevacizumab therapy is associated with known skin-related side effects, such as rash, mucosal hemorrhage, and hemorrhagic ulcers. While subungual "splinter" hemorrhage is a documented side effect of VEGF receptor antagonists and Raf protein inhibitors, there are no prior reports of bevacizumab-induced subungual hemorrhage to the best of our knowledge. Thus, we present the case of a 71-year-old female diagnosed with bilateral age-related macular degeneration, who, during six months of intravitreal bevacizumab treatment, began noticing fingernail discoloration, described as similar to that of a bruise. Given our patient's history of bevacizumab therapy and the documented reports of bevacizumab-associated mucosal and ulcerative hemorrhage, we hypothesize that the discoloration and hemorrhage are likely unreported adverse effects associated with bevacizumab therapy.

渗出性(湿性)年龄相关性黄斑变性可以用血管内皮生长因子(VEGF)抑制单克隆抗体贝伐单抗治疗。目前,贝伐单抗治疗与已知的皮肤相关副作用有关,如皮疹、粘膜出血和出血性溃疡。虽然趾骨下“碎片”出血是VEGF受体拮抗剂和Raf蛋白抑制剂的副作用,但据我们所知,之前没有贝伐单抗诱导的趾骨下出血的报道。因此,我们提出了一例71岁的女性诊断为双侧年龄相关性黄斑变性,谁,在六个月的玻璃体内贝伐单抗治疗,开始注意到指甲变色,描述为类似瘀伤。考虑到患者的贝伐单抗治疗史以及贝伐单抗相关粘膜和溃疡性出血的文献报道,我们假设变色和出血可能是与贝伐单抗治疗相关的未报道的不良反应。
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Dermatology online journal
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