Deborah L. Cummins

Cutaneous malignant melanoma.

Skin cancer has become the most common neoplasm in the United States. With early diagnosis and appropriate management, most skin cancers have an overall 5-year survival rate of 95%. Cutaneous malignant melanoma (CMM), however, has a significantly higher morbidity and mortality, resulting in 65% of all skin cancer deaths. Although the long-term survival rate for patients with metastatic melanoma is only 5%, early detection of CMM carries an excellent prognosis, with surgical excision often being curative. Primary care physicians can play a critical role in reducing morbidity and mortality from CMM by recognizing patients at risk, encouraging the adoption of risk-reducing behaviors, and becoming adept at identifying suspicious lesions.

Treatment of pyoderma gangrenosum with intravenous immunoglobulin

Background  Intravenous immunoglobulin (IVIG) is increasingly being used to treat inflammatory and autoimmune disease.

Mycobacterium marinum with different responses to second-generation tetracyclines

Background  Persistent cutaneous infections with Mycobacterium marinum can follow exposure of injured skin to contaminated water or fish, and can be treated with second‐generation tetracyclines in addition to other antimicrobials. Due to the rarity of this infection, there are few data comparing the different treatment alternatives.

Generalized necrobiosis lipoidica treated with a combination of split‐thickness autografting and immunomodulatory therapy

A 14-year-old boy presented for management of chronic and recalcitrant large ulcerative lesions on the extremities. These lesions appeared at 18 months of age as erythematous papules that progressively enlarged, becoming painful and ulcerated. His growth and development were normal. Evaluations for underlying immunodeficiencies and autoimmune and inflammatory disorders were consistently negative. He had no family or personal history of diabetes mellitus. Physical examination revealed several 6–11 cm in diameter atrophic violaceous infiltrated plaques affecting the extremities. The majority of the lesions had central deep ulcerations and crusting. Mucous membranes were not affected and there was no palmoplantar involvement. Histologic examination of a deep incisional skin biopsy of an ulcerated site revealed extensive deep dermal and subcutaneous palisading granulomas (Fig. 1). There were no significant neutrophilic infiltrates and no evidence of vasculitis or cholesterol clefting. Alcian blue staining showed scant mucin

Downregulation of NDUFA1 and other oxidative phosphorylation-related genes is a consistent feature of basal cell carcinoma.

Abstract:  Basal cell carcinoma (BCC) is the most common cutaneous malignancy that, like other tumours, possesses a heterogeneous genetic composition. In order to select genes with consistent changes in expression among these tumours, we analysed BCC microarray expression data by using a novel approach, termed correlative analysis of microarrays (CAM). CAM is a nested, non‐parametric method designed to qualitatively select candidates based on their individual, similar effects upon an array‐wide closeness measure. We applied the CAM method to expression data generated by two‐channel cDNA microarray experiments, where 21 BCC and patient‐matched normal skin specimens were examined. Fifteen candidate genes were selected, with six overexpressed and nine underexpressed in BCC vs. normal skin. Five of the nine consistently downregulated genes in the tumour samples are involved in mitochondrial function and the oxidative phosphorylation (OXPHOS) pathway. One of these genes was the 7.5‐kDa subunit, NADH dehydrogenase (ubiquinone) alpha subcomplex‐1 (NDUFA1), an accessory component of OXPHOS complex‐I that is essential for respiratory activity. These findings support the hypothesis that irregularities in mitochondrial function are involved in neoplasia. Suppression of NDUFA1 expression could represent a key pathogenic mechanism in the development of BCC.

Henoch–Schönlein purpura in pregnancy

Henoch–Schönlein purpura (HSP) is an IgA‐mediated small vessel vasculitis which commonly involves the skin, gastrointestinal system and kidneys. Numerous HSP triggers have been identified, and pregnancy has been reported as an exacerbating factor. After a pregnant woman had been diagnosed as having new‐onset HSP, we reviewed all cases of immunofluorescence‐proven HSP evaluated by the Department of Dermatology at the Johns Hopkins Hospital between 1990 and 2002, and report three cases of HSP occurring during pregnancy. Two patients developed new‐onset HSP, one at 16 weeks gestation and one at 22 weeks, while the third developed a recurrence of HSP at 12 weeks gestation after 19 years of remission. We conclude that pregnancy may be a trigger for HSP onset or recurrence in susceptible individuals.

Extensive sebaceous/epidermal nevus associated with cardiac arrhythmia.

throughout life, especially in lesions caused by HPV types 5 and 8, in areas exposed to light (3). Treatment is difficult and sometimes frustrating; photoprotection is essential in attempting to prevent disease progression to cancer (epidermoid carcinoma). In a study performed on 11 patients with epidermoid carcinoma secondary to EV, the maximum survival was 54 years (4). Although the differential diagnosis between true EV and a disseminated picture of flat warts is very difficult, especially in immunodepressed patients (5), the presence of koilocytes in the upper layers of the epidermis is an important sign of genodermatosis (6). The hybridization ofDNAused to identify the types ofHPV shows that the viruses involved are 2, 3, 5, 8, 9 12, 14, 15, and 17 (5)—the most commonly found virus is HPV 3, which is also a frequent cause of flat warts (3). Cellular immunodeficiency may increase the risk of infectiondisseminationbyHPV,but the incidenceof true EV is rare. This supports the requirement for genetic susceptibility to develop the disease (3). Morrison et al showed the increased possibility of dysplasia in lesions of patients with EV andHIV or kidney transplantation (5). Our patient has a set of clinical factors that make him different—HIV and HCV infections, cellular immunodeficiency and multiple lesions characteristic of EV, in areas exposed to light.Regular follow-upof this teenaged patient may ensure the clinical and laboratory control of conditions that would favor the development of severe skin neoplasms. In addition, management of this patient is complicated by his social condition.