Geoffrey Alan Watson

An unusual case of basal cell carcinoma of the vulva with lung metastases

Basal cell carcinoma (BCC) is the most common non-melanomatous skin cancer, typically arising in sun-exposed areas such as the head and neck. Defective signaling through the Hedgehog (HH) signaling pathway forms the molecular basis for BCC. Surgery remains the mainstay of treatment. Basal cell carcinoma of the genital tract is rare as is metastatic BCC. We report a case of metastatic BCC in a young woman with previously resected vulval BCC presenting six years later with inguinal nodal recurrence and multiple lung metastases.

Progressive multifocal leukoencephalopathy secondary to rituximab-induced immunosuppression and the presence of John Cunningham virus: a case report and literature review

We present the case of a 60-year-old man who developed subacute neurologic changes, in the setting of stage III non-Hodgkins follicular lymphoma, and was treated with induction chemotherapy, followed by a year of maintenance rituximab. Magnetic resonance imaging of the brain with gadolinium was pathognomonic for progressive multifocal leukoencephalopathy (PML). He was treated with sequential plasmapheresis and intravenous immunoglobulin with clinical improvement. A literature review of the diagnostic workup of rituximab-induced PML was undertaken. This case and the literature review demonstrate the important role of magnetic resonance imaging of the brain in diagnosis and follow-up of rituximab-induced PML. Specific radiologic features in combination with cerebrospinal fluid can be diagnostic and avoid the morbidity and mortality of a diagnostic brain biopsy. Plasmapheresis and intravenous immunoglobulin have a therapeutic role and demonstrate symptom improvement and disease control. Follow-up imaging in combination with clinical response is important in demonstrating a treatment response.

Real-World Experience of Palbociclib-Induced Adverse Events and Compliance With Complete Blood Count Monitoring in Women With Hormone Receptor–Positive/HER2-Negative Metastatic Breast Cancer

Micro‐Abstract Palbociclib therapy in hormone receptor–positive metastatic breast cancer patients may result in adverse events such as neutropenia, and stringent monitoring of complete blood count is advised. The current study found good compliance with guidelines and demonstrated that dose adjustments are not associated with progressive disease. We also report a high incidence of thromboembolic events. Background: The cyclin‐dependent kinase 4/6 inhibitor palbociclib has emerged as a novel therapeutic agent in metastatic breast cancer. Neutropenia is commonly observed, and thus stringent treatment guidelines regarding complete blood count (CBC) monitoring have been developed. The aim of this study was to provide a real‐world experience of the toxicities associated with palbociclib therapy and to evaluate compliance with CBC monitoring. Patients and Methods: We performed a retrospective single‐center audit of hormone receptor–positive metastatic breast cancer patients treated with palbociclib over a 6‐month period in an Irish tertiary referral hospital. Results: A total of 64 patients were included in the analysis. Palbociclib was most commonly used in combination with letrozole (n = 40). A total of 28 patients (44%; 95% confidence interval, 31.2‐56.2) had treatment deferrals due to neutropenia, with a median time to first deferral of 4 weeks. Fifteen patients (23%; 95% confidence interval, 15.4‐37.7) required dose adjustments; however, there was no association with an increased risk of progressive disease (P = .56). Only 3 patients discontinued treatment as a result of poor tolerance. Adverse events were as expected; however, 7 venous thromboembolic events were reported. Conclusion: Compliance was good with existing CBC monitoring guidelines. We observed an 11% incidence of venous thromboembolic events, a significant increase from 2% reported in the PALOMA‐3 trial. Further studies are recommended to determine if prophylactic anticoagulation may benefit these patients.

Primary vaginal melanoma in the setting of mucosal melanosis - A case report and literature review

We present a rare case of localised, biopsy proven vaginal melanoma and vaginal melanosisin a Caucasian 66 year old who presented with postmenopausal bleeding. A systematic literature review of journal articles published between December 2013 and November 2015 was performed for studies conducted in Europe and the United States of America using Medline and Pubmed. Articles were selected for review if they included large (over 10 cases)retrospective analysis, epidemiological review and genetic analysis of primary vaginal melanoma and/or primary vulvar melanoma.Our findings demonstrate the challenges of researching and treating rare diseases.