Clifford S. Perlis

Primary cutaneous adenoid cystic carcinoma

Primary cutaneous adenoid cystic carcinoma is a rare, slow-growing malignancy first described by Boggio in 1975. This tumor characteristically consists of basophilic cells with a distinct adenoid or cribriform pattern in the mid to deep reticular dermis. Modified myoepithelial cells with prominent basement membrane material often surround true lumina. Definitive diagnosis relies on the characteristic histologic features and the exclusion of metastatic disease. We describe two patients who presented with painful papules of the scalp and were successfully treated with wide local excision.

Multiple antithrombotic agents increase the risk of postoperative hemorrhage in dermatologic surgery

BACKGROUND Studies show that holding single antithrombotic agents perioperatively increases the risk of acute thrombotic events and does not significantly decrease the risk of bleeding complications in dermatological surgery. Recent data suggest that selected patients may benefit from combination therapy in preventing acute thrombotic events. OBJECTIVE We sought to evaluate postoperative bleeding complications in patients who underwent Mohs micrographic surgery while using multiple agents perioperatively compared with patients using a single agent or none at all. METHODS We conducted a retrospective chart review of patients treated in one academic Mohs micrographic surgery department during 1 year. RESULTS Patients taking two or more agents at the time of surgery were more likely to bleed than those taking one agent or none at all (P = .0016, Fishers exact). LIMITATIONS Small sample size and retrospective nature were limitations. CONCLUSION Perioperative use of more than one antithrombotic agent increases postoperative bleeding risk.

A better prognosis for Merkel cell carcinoma of unknown primary origin

BACKGROUND There is limited evidence that Merkel cell carcinoma (MCC) arising from a nodal basin without evidence of a primary cutaneous (PC) site has better prognosis. We present our experience at 2 tertiary care referral centers with stage III MCC with and without a PC site. METHODS Fifty stage III MCC patients were identified between 1996 and 2011. Clinical data were analyzed, with primary endpoints being disease-free survival and overall survival. RESULTS Of stage III patients, 34 patients presented with a PC site and 16 patients with an unknown primary (UP) site. Treatment strategies varied; of patients with UP vs. PC sites, 25% vs. 44% underwent combined regional lymphadenectomy and radiation, with an additional 25% vs. 15% receiving chemotherapy. The median disease-free survival for a UP site was not reached vs. 15 months for a PC site (hazards ratio = .48, P = .18). The median overall survival for a UP site was not reached vs 21 months for a PC site (hazards ratio = .34, P = .03). Multivariate analysis showed that UP status was a significant factor in overall survival (P = .002). CONCLUSIONS Stage III MCC with a UP site portends a better prognosis than MCC with a PC site.

Measurement of tanning dependence

Indoor tanning has been found to be addictive. However, the most commonly used tanning dependence measures have not been well validated.

Minimal Erythema Dose (MED) testing.

Ultraviolet radiation (UV) therapy is sometimes used as a treatment for various common skin conditions, including psoriasis, acne, and eczema. The dosage of UV light is prescribed according to an individuals skin sensitivity. Thus, to establish the proper dosage of UV light to administer to a patient, the patient is sometimes screened to determine a minimal erythema dose (MED), which is the amount of UV radiation that will produce minimal erythema (sunburn or redness caused by engorgement of capillaries) of an individuals skin within a few hours following exposure. This article describes how to conduct minimal erythema dose (MED) testing. There is currently no easy way to determine an appropriate UV dose for clinical or research purposes without conducting formal MED testing, requiring observation hours after testing, or informal trial and error testing with the risks of under- or over-dosing. However, some alternative methods are discussed.

Cutaneous plasmablastic lymphoma

Plasmablastic lymphoma is a variant of diffuse large B-cell lymphoma occurring in immunocompromised individuals. Multiple organ sites may be involved; however, cutaneous involvement has been rarely reported in the medical literature. To date, there have been only 7 reports of cutaneous plasmablastic lymphoma without systemic involvement. We report a case of isolated cutaneous plasmablastic lymphoma occurring in an HIV-positive man with more than 10 years of follow-up.

Absolute lymphocyte count: A potential prognostic factor for Merkel cell carcinoma

BACKGROUND Absolute lymphocyte count (ALC) is a laboratory value commonly obtained during workup of patients with Merkel cell carcinoma (MCC). OBJECTIVE We report the prognostic impact of ALC as a surrogate of immune status in MCC. METHODS A complete blood cell count was available for 64 patients with MCC in the month before definitive surgery, chemotherapy, or radiation. Statistical analysis was performed with classification and regression tree analysis, log rank test, and Cox model. RESULTS Median overall survival (OS) for the cohort was 97 months. Median OS for patients with an ALC less than 1.1 k/mm(3) was 18.8 versus 110.1 months for those with ALC greater than or equal to 1.1 k/mm(3) (P = .002, hazard ratio 0.29). Multivariate analysis of OS controlling for ALC, sex, stage, adjuvant chemotherapy, hematologic malignancy, and immunosuppression demonstrated ALC as a prognostic factor (P = .03). Disease-free survival at 36 months for ALC less than 1.1 k/mm(3) was 26.9% versus 64.4% for those with ALC greater than or equal to 1.1 k/mm(3) (P = .01). ALC was not a significant predictor for disease-free survival on multivariate analysis (P = .12). LIMITATIONS This is a single-institution retrospective data set. CONCLUSION ALC is associated with OS but not disease-free survival in MCC using a threshold of less than 1.1 k/mm(3). This test may provide additional prognostic information for patients with MCC.

Surgery in the Multimodality Treatment of Sinonasal Malignancies

M alignancies of the paranasal sinuses represent a rare and biologically heterogeneous group of cancers. Understanding of tumor biology continues to evolve and will likely facilitate the development of improved treatment strategies. For example, some sinonasal tumors may benefit from treatment through primarily nonsurgical approaches, whereas others are best addressed through resection. The results of clinical trials in head and neck cancer may not be generalizable to this heterogeneous group of lesions, which is defined anatomically rather than through histogenesis. Increasingly sophisticated pathologic assessments and the elucidation of molecular markers, such as the human papilloma virus (HPV), in sinonasal cancers have the potential to transform the clinical management of these malignant neoplasms. Published reports often suggest that treatment approaches that include surgery result in better local control and survival. However, many studies are marked by selection bias. The availability of effective reconstruction makes increasingly complex procedures possible, with improved functional outcomes. With advances in surgery and radiation, the multimodal treatment of paranasal sinus cancers is becoming safer. The use of chemotherapy remains a subject of active investigation.

Psychosocial Correlates of Sunburn among Young Adult Women

Skin cancer is an increasingly common disease, particularly among young adult women. Sunburn early in life is a risk factor for skin cancer. Few studies have reported on psychosocial correlates of sunburn. The current study consisted of an online survey of undergraduate women from a university in the northeastern part of the USA. A logistic regression demonstrated that young women who reported a history of four or more sunburns were significantly more likely to report fair skin, higher perceived susceptibility to skin cancer, greater perceived benefits of tanning (e.g., appearance enhancement), lower perceived control over skin protection, and more frequent sunscreen use. Sunbathing was not associated with a greater number of sunburns. These results suggest that young women who sunburn more often possess other skin cancer risk factors, are aware of their susceptibility to skin cancer, and try to use sunscreen, but feel limited control over their skin protection behavior and are not less likely to sunbathe than others. Therefore, interventions are needed to assist high risk young women in asserting more control over their sun protection behavior and perhaps improve the effectiveness of the sunscreen or other skin protection methods they do employ.

Dermabrasion for Actinic Cheilitis

Actinic cheilitis (AC) is a common premalignant condition of the lips resulting from chronic or excessive ultraviolet exposure. Many different treatment modalities have been reviewed in the literature. Current methods include topical 5-fluorouracil, imiquimod, photodynamic therapy, chemical peels, cryosurgery, electrodesiccation and curettage, carbon dioxide laser, and vermilionectomy with or without mucosal advancement.