Collin M. Costello

The role of the ugly duckling sign in patient education

Background The ABCDE (with A standing for asymmetry, B for border irregularity, C for color variegation, D for diameter larger than 6 mm, and E for evolution) rule for melanoma (MM) recognition is widely taught in the general population. The ugly duckling (UD) sign is an alternate MM recognition strategy that is not generally taught. Objective To compare the sensitivity, specificity, and accuracy of MM recognition with UD sign and the ABCD rule in a general population. Methods Participants were randomized into either the ABCD or UD arm of the study. An educational tutorial on their respective teaching method followed. Participants were subsequently tested using images of 9 lesions (7 nevi and 2 MMs) and asked to categorize each image as MM or not MM. Results A total of 51 participants were randomized to the ABCD group and 50 to the UD group. The sensitivity for MM recognition of both groups was similar. The specificity and accuracy for MM recognition was significantly higher (P =.02, P = .02) in the UD group. Limitations The E for evolution in the ABCDE rule was not tested. No follow‐up knowledge retention test was conducted. Conclusion The UD sign significantly improved accuracy and specificity of MM recognition. We recommend adding the UD sign to patient education in addition to the traditional ABCDE rule.

Frequent loss of inositol polyphosphate‐5‐phosphatase in oropharyngeal squamous cell carcinoma

There is an incomplete understanding in the pathogenesis of oropharyngeal squamous cell carcinoma (OPSCC) and cancer broadly. It is essential to discover new pathways of normal cell-cycle regulation and oncogenesis. We identified that the loss of inositol polyphosphate-5-phosphatase (INPP5A) may play a role in the development and progression of cutaneous squamous cell carcinoma (SCC).1 Loss of INPP5A has been previously linked to cancer development and progression.2 n nThis article is protected by copyright. All rights reserved.

Educational and practice gaps in the management of volar melanocytic lesions

The benign and malignant patterns of acral melanocytic naevi (AMN) and acral melanomas (AM) have been defined in a series of retrospective studies. A three‐step algorithm was developed to determine when to biopsy acral melanocytic lesions. This algorithm has only been applied to a Japanese population.

The Prognostic Value of Inositol Polyphosphate 5-Phosphatase in Cutaneous Squamous Cell Carcinoma

Background: Inositol polyphosphate 5‐phosphatase (INPP5A) has been shown to play a role in development and progression of cutaneous squamous cell carcinoma (cSCC). The goal of the current study was to explore the prognostic value of INPP5A expression in cSCC. Methods: A total of 189 cases of actinic keratosis and SCC in 174 patients were identified; clinical and outcome data were abstracted, histopathology was rereviewed, and immunohistochemical staining and interpretation was performed for INPP5A. Results: The majority of tumors (89.4%) had an INPP5A score of 2 or 3. No patients had complete loss of INPP5A. Tumors with an INPP5A score of 1 were more likely to be intermediate‐ to high‐risk tumors (Brigham and Womens Hospital stage ≥T2a 85.0% vs 23.7% [P < .0001]) characterized by a larger diameter (2.4 cm vs 1.3 cm [P = .0004]), moderate‐to‐poor differentiation (86.7% vs 17.6% [P < .0001]), and perineural invasion (37.5% vs 5.3%, [P < .0001]). An INPP5A score of 1 was associated with a worse 3‐year survival (a rate of 42.3% [hazard ratio, 2.81, P = .0006]) and a local metastasis rate of 48.0% (hazard ratio, 4.71; P < .0001). Conclusions: Low INPP5A scores are predictive of aggressive tumors and may be a useful adjunct to guide clinical management of cSCC.

Clinical and histopathologic features of paraneoplastic granuloma annulare in association with solid organ malignancies: A case–control study

Background Granuloma annulare (GA) is a granulomatous skin eruption rarely associated with cancer. We report seven cases of paraneoplastic GA in association with solid organ malignancy. Objective To compare the clinical and histopathological features of paraneoplastic GA to case‐matched controls of classic GA. Methods Retrospective chart and histopathological review of 7 individuals and 13 age‐ and sex‐matched controls. Paraneoplastic GA was defined as GA occurring within 6 months of the diagnosis of solid organ malignancy and/or persistent GA that resolved with cancer treatment. Results Most cases of paraneoplastic GA were associated with lung cancer (4/7). The clinical and histopathological features of paraneoplastic and classic GA were similar. Compared to classic GA, paraneoplastic GA cases were more often generalized disease (6/7 vs 6/13), refractory to treatment, and had a perivascular inflammatory cell infiltrate (5/7 vs 2/13). All cases of paraneoplastic GA that underwent definitive treatment of their cancer improved. Limitations Single‐institution, retrospective review with a small sample size. Conclusion Paraneoplastic GA is rare, similar to classic GA, and refractory to treatment. We advocate for age‐appropriate screening in individuals with GA that is nonresponsive to multiple lines of systemic treatment and evaluating patients with concerning signs or symptoms for an underlying neoplasm.

The density and distribution of acral melanocytic nevi and acral melanomas on the plantar foot

100%, the persistently low match rates in dermatology imply that accelerated creation of dermatology residency positions would yield a nearly 1:1 increase in matched applicants and, in turn, in dermatologists entering practice annually. The Balanced Budget Act (1997) capped the number of residents considered in calculating direct and indirect graduate medical education reimbursement at 1996 levels. Thus, to expand the number of residency positions as a means of addressing a shortage of dermatologists, self-funding or other non-Medicare funding would be necessary.

Melanoma mimicking Rosai-Dorfman disease

Despite well‐defined clinical and histopathological features of melanoma, atypical presentations mimicking other skin disorders can result in a delayed diagnosis or misdiagnosis and subsequent inappropriate treatment. Rosai‐Dorfman disease (RDD) is a rare histiocytic disorder with unique clinical and histopathological features. We report a case of melanoma treated with cryotherapy that mimicked RDD both clinically and histopathologically. We compare this RDD‐like melanoma to classic RDD, outlining the importance of clinicopathological correlation prior to treatment, as well as the potential pitfalls in diagnosis after cryotherapy of pigmented lesions.

Systemic scleroderma and lupus panniculitis with atypical clinical features: A case report and comprehensive review

P anniculitis is defined as inflammation of the subcutaneous tissue. Two well-known variants, morphea profunda (MP) and lupus erythematosus panniculitis (LEP), can be difficult to distinguish clinically and histologically. MP typically affects the legs, forearms, and trunk and is characterized by a bound-down inflammatory plaque or nodule with an overlying brown-red color with peau d’orange change. Homogenized collagen is seen throughout the dermis. LEP is characterized clinically by crops of tender, subcutaneous nodules involving the proximal extremities, trunk, face, and scalp. The resolved disease leaves depressed, atrophic plaques with overlying scar-like changes. Histopathologically, LEP shows extensive involvement of the dermis and subcutaneous fat with extensive periseptal and lobular lymphocytic infiltrate, hyaline necrosis, calcification, and a vacuolar interface reaction with pigment incontinence. Despite the epidermal involvement histopathologically, discoid lupus erythematosus (DLE) or DLE-like lesions are less commonly seen overlying LEP but may be seen at other sites. Amajor distinction of LEP from MP is the hyaline necrosis of the adipose tissue and the positive direct immunofluorescence. We report a case of systemic scleroderma or systemic sclerosis (SSc) with LEP and distinctive DLE-like lesions. We review the literature on this rare co-occurrence and delineate some common clinical findings.

Dermoscopic features of cutaneous Langerhans cell histiocytosis

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