Dana Langner

Comorbidities, treatment, and outcome in severe anogenital inverse acne (hidradenitis suppurativa): a 15-year single center report.

Acne inversa (hidradentitis suppurativa; AI) is a severe chronic relapsing inflammatory skin disease of unknown cause. Anogenital AI has the strongest negative impact on quality of life and causes great disability.

Basal cell carcinoma of the outer nose: Overview on surgical techniques and analysis of 312 patients

Background: Basal cell carcinoma of the nose is common, with a potential of local recurrence and high-risk features. Materials and Methods: We provide a review on anatomy of the nose, tumour surgery and defect closure on the nose. We analysed our own patients with nasal BCC of a 24 months period. Results: We identified 321 patients with nasal BCC. There was a predominance of female patients of 1.2 to 1. The mean age was 74.8 years. Slow Mohs technique was employed for all tumours until 3D tumour-free margins were achieved. That resulted on average in 1.8 ± 0.7 Mohs stages. The most common histologic types were solitary (n = 182), morpheic (79), and micronodular (20), Perineural infiltration was evident in 56 tumours. Primary closure after mobilisation of soft tissue was possible in 105 BCCs. Advancement flaps were used in 91 tumours, rotation flaps in 47, transposition flaps in 34 tumours, and combined procedures in 6 cases. In 36 patients full-thickness skin grafting was performed. In two patients healing by second intention was preferred. Partial flap loss was seen in four patients (1.4%). All of them had significant underlying pathologies. None of the tumours treated showed a relapse during the observation time. However, this is a limitation of the present study since follow-up was on average only 10 months. Conclusions: BCCs of the nose are common. Only 3D-controlled micrographic surgery (Mohs or slow Mohs) guarantee a high rate of complete tumour removal and a very low risk of recurrence.

Pyogenic Granuloma – A Common Benign Vascular Tumor with Variable Clinical Presentation: New Findings and Treatment Options

Pyogenic granuloma is a common benign vascular tumour occurring in all ages. Both skin and mucous membranes can be affected. Of pathogenetic importance are trauma, BRAF mutations and probably herpes virus type 1, Orf virus and/or human papilloma virus type 2. The tumour consists of capillary proliferations, venules and fibromyxoid stroma. The development of a lesion occurs in three stages and bleeding is a common symptom. The tumour can mimic various other vascular lesions, solid tumours, and soft tissue infections. In recent years, targeted tumour therapies have become the most common cause of drug-induced pyogenic granulomas. The backbone of treatment is surgical procedures including laser therapy. New developments in medical drug therapy include topical and systemic beta-adrenergic receptor antagonists timolol and propranolol. Drug therapy is an alternative for young children, ocular and periungual pyogenic granuloma.

Isolated plexiform schwannoma of the hand

BACKGROUND The plexiform schwannoma, a peripheral nerve sheath tumor, is a very rare entity. But dermatologists should be familiar with since they may be the first who make diagnosis possible by taking a deep biopsy. MAIN OBSERVATION A 24-year-old male presented with multiple asymptomatic subcutaneous nodules of the palmar side of his right hand. Histologic investigations revealed a plexiform schwannoma with numerous Antoni-A areas. There was no evidence of neurofibromatosis type 1 or 2. CONCLUSIONS Plexiform schwannoma of the hand is a rare nerve sheath tumor. In individual (symptomatic) cases hand surgery is an option that needs a critical indication. In every case histologic investigations are mandatory to confirm the diagnosis and not to overlook the malignant variant of this disease.

Epidermoid Cysts – A Wide Spectrum of Clinical Presentation and Successful Treatment by Surgery: A Retrospective 10-Year Analysis and Literature Review

Epidermoid cysts are common benign lesions of hair-bearing, and less often glabrous skin. They can also occur in oral mucosa and internal organs. In case of cutaneous lesions, an epidermal punctum is a clinical diagnostic hallmark. The clinical presentation is variable leading to some differential diagnoses. Diagnosis of epidermoid cysts needs histopathological confirmation – not only of the potential of malignant transformation. The treatment of choice is surgery. We report a retrospective analysis of 2159 epidermoid cysts treated surgically. Most of the cases can be performed under local anaesthesia. The complication rate of 2.2% is low. To avoid relapses, the cyst wall has to be removed completely. Rare genetic disorders with multiple cysts are Gardner and Lowe syndrome.

Dermatofibrosarcoma Protuberans: Retrospective Single Center Analysis Over 16 Years

Dermatofibrosarcoma protuberans (DFSP) is rare mesenchymal neoplasia with a high risk of local recurrence but a low risk of metastatic spread. Tumor cells express CD34 and show a characteristic translocation t(17;22)(q22;q13). We analysed the documented cases at the Department of Dermatology and Allergology between 08/2001 and 08/2017. The diagnosis had been confirmed by histology and immunohistology in all cases. We identified four adults and a pediatric patient with DFSP. All patients were treated by wide surgical excision and controlled by three-dimensional histologic margin control. We observed no recurrence and no metastatic spread. We discuss prognostic factors and emerging treatments.

Acrocyanosis – A Symptom with Many Facettes

Acrocyanosis is an uncommon complaint belonging to the acro-syndromes. It typically presents with coolness and bluish discolourations of hands, feet, ears, nose, lips and nipple. The most frequently affected parts of the body are the hands. This review discusses physical factors, vascular disorders, infectious diseases, haematological disorders, solid tumours genetic disorders, drugs, eating disorders, and spinal disease presenting as or leading to acrocyanosis.

Scalping Surgery – Dermatologic Indications beyond Curative Primary Skin Cancer Surgery

Skin tumours are among the most frequent tumour types of mankind. In the case of large tumours, field cancerization, or satellitosis scalping surgery is a possible option. The procedure can also be used in a palliative setting with tumour debulking. Less common indications are multiple benign tumours of the scalp and chronic inflammatory scalp dermatoses not responding to medical treatment. We present a case series and discuss surgical modalities beyond curative surgery of primary skin cancer.

Rapid Evolving Unilateral Indurated Oozing Facial Plaques in a Patient with Head-and-Neck Cancer: Peripheral T-Cell Lymphoma Not Otherwise Specified (NOS)

BACKGROUND The sudden development of facial plaques and nodules may be an alarming clinical sign for underlying malignancies. Nevertheless, a broad range of inflammatory and infectious diseases must be considered as well in the differential diagnosis. CASE REPORT We report on a 53-year-old male patient with a left-sided cheek infiltration with oozing but no lymphadenopathy. He had a medical history of head-and-neck cancer. The primary differential diagnosis was herpes zoster with secondary impetiginization or pyoderma facial. About eight weeks later, the patient presented with progressive formation of nodules and plaques on the face and isotretinoin was stopped. Skin biopsy suggested mycosis fungoid and an oral treatment with bexarotene was started. After limited response for another eight weeks, he returned later with massive facial swelling, nodules and impetiginization. Another skin biopsy was performed to exclude diagnostic error or investigate possible disease progression. Microscopic evaluation and multiplex-polymerase chain reaction confirmed the diagnosis of peripheral T-cell lymphoma, not otherwise specified (PTL-NOS), stage Ia (T1 N0 M0). Imaging techniques excluded metastatic spread. By interdisciplinary tumour board, R-CHOP (rituximab, cyclophosphamide, hydroxyl-doxorubicin, vincristine, and prednisolone) was recommended and initiated by hemato-oncologists. CONCLUSIONS PLT-NOS confirmed in the present patient has a poor prognosis with a 5-year survival rate of less than 20%.

Posttraumatic panniculitis – Case series and literature review

Background: Traumatic panniculitis is a rare inflammatory disease of subcutaneous adipose tissue. Objective: We analyzed the patients’ files for traumatic panniculitis in a single-center study. Materials and methods: This is a retrospective analysis of patients seen between 04/2002 and 09/2017 at our department. Results: We identified four adult patients, three females and one male. The age range of patients was between 23 years and 50 years. In three cases the lower legs were affected, in one case the lumbar region. A blunt trauma was reported in 100%. Pain and subcutaneous swelling were the leading symptoms. Previous symptomatic medical treatment failed. Surgical treatment was successfully performed in three cases without relapse. Streptococcus dysgalactiae was identified in one patient. Conclusion: Traumatic panniculitis is a rare disorder with a female predominance. Surgical treatment was successful in chronic cases, whereas medical treatment had failed. Correspondence to: U Wollina, Department of Dermatology and Allergology and Center of Physical and Rehabilitative Medicine, Academic Teaching Hospital Dresden-Friedrichstadt, Friedrichstrasse 41, 01067, Dresden, Germany, E-mail: wollina-uw@khdf.de